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Sample records for arthroscopic anterior cruciate

  1. Arthroscopic Suture Fixation in Femoral-Sided Avulsion Fracture of Anterior Cruciate Ligament

    PubMed Central

    Prasathaporn, Niti; Umprai, Vantawat; Laohathaimongkol, Thongchai; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

    2015-01-01

    A femoral-sided avulsion fracture of the anterior cruciate ligament (ACL) is a rare and challenging condition. Most reported cases have occurred in childhood or adolescence. Many techniques of ACL repair have been reported, and in recent years, techniques in arthroscopic surgery have been developed and have become ever more popular with orthopaedic surgeons. We created a technique of arthroscopic ACL repair with suture anchor fixation for a femoral-sided ACL avulsion fracture. This technique saves the natural ACL stump. It is available for cases in which creation of a tibial tunnel is not allowed. Moreover, it does not require a skin incision for fixation on the far femoral cortex and, therefore, does not require a second operation to remove the fixation device. The arthroscopic technique also has a good cosmetic outcome. PMID:26258035

  2. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-01-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  3. Hospital Charges and Practice Patterns for General and Regional Anesthesia in Arthroscopic Anterior Cruciate Ligament Repair

    PubMed Central

    Foster, Brock D.; Terrell, Rodney; Montgomery, Scott R.; Wang, Jeffrey C.; Petrigliano, Frank A.; McAllister, David R.

    2013-01-01

    Background: Anesthetic use for arthroscopic anterior cruciate ligament (ACL) reconstruction may display variability in hospital charges and utilization in the United States. Purpose: To evaluate practice patterns and hospital charges for anesthesia in arthroscopic ACL reconstruction. Study Type: Cross-sectional study. Methods: The PearlDiver Patient Records Database, a national database of insurance billing records, was searched using the current procedural terminology (CPT) codes for arthroscopic ACL reconstruction in combination with different types of anesthesia. The search included the years between 2004 and 2009. Age, sex, number of procedures performed, geographic region, and hospital charges for each type of anesthesia were recorded and compared. Anesthetic types were categorized as general anesthesia (GA) only, GA with concomitant single femoral injection, GA with concomitant other regional anesthesia (RA), single femoral injection only, or other RA only. Results: Between 2004 and 2009, a total of 53,968 arthroscopic reconstructive procedures were identified. The mean per patient hospital charge for GA alone, GA in combination with single femoral injection, GA in combination with other RA, single femoral injection alone, and RA alone was $1065 (63% of cases), $1614 (29%), $1849 (4%), $630 (3%), and $612 (1%), respectively. The use of GA in combination with RA or single femoral nerve injection significantly increased during this time period (P = .004 and P < .001, respectively). Conclusion: The mean per patient hospital charges for arthroscopic ACL reconstruction varied with the mode of anesthesia utilized, where regional anesthetic techniques alone were least expensive. RA alone was utilized infrequently, and there was a significant increase in the rate of utilization of GA in combination with any form of RA. Clinical Relevance: This study provides information on current trends and hospital charges for anesthesia in arthroscopic ACL reconstruction. PMID:26535248

  4. Intraligamentous ganglion cysts of the anterior cruciate Ligament: MR findings with clinical and arthroscopic correlations

    SciTech Connect

    Do-Dai, D.D.; Youngberg, R.A.; Lanchbury, F.D.; Pitcher, J.D. Jr.; Garver, T.H.

    1996-01-01

    Magnetic resonance findings with clinical and arthroscopic correlation of intraligamentous cysts of the anterior cruciate ligament (ACL) are presented. Three cases of intraligamentous cysts of the ACL were identified out of 681 knee MRI examinations over a 2-year period. Arthroscopy and postoperative MRI were performed in all three patients, each of whom experienced knee pain with extreme flexion and extension. In all three cases the intraligamentous cyst was homogeneously hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging relative to the ACL. Two of the three ACL cysts required a 70{degrees} scope for adequate visualization and establishment of posteromedial and posterolateral portals for arthroscopic treatment. One cyst could not be visualized arthroscopically and probing of the ACL from the anterior portal resulted in drainage of the cyst. No patient had presence of ACL cyst on follow-up MRI or recurrence of symptoms at a mean of 24 months. Intraligamentous cyst of ACL is a rare cause of knee pain. It should be suspected in patients having chronic pain with extremes of motion. Magnetic resonance findings are diagnostic and help to guide arthroscopy. 14 refs., 3 figs.

  5. Graft infection following arthroscopic anterior cruciate ligament reconstruction: a report of four cases.

    PubMed

    Wee, James; Lee, Keng Thiam

    2014-04-01

    Septic arthritis following arthroscopic anterior cruciate ligament reconstruction (ACL) is a rare complication and associated with severe morbidity. Its risk factors include (1) concomitant procedures during the reconstruction, (2) previous knee surgery, (3) allograft usage, (4) peri-operative wound contamination, and (5) presence of intra-articular foreign bodies. We present a series of 3 men and one woman aged 22 to 35 years who developed septic arthritis following ACL reconstruction. The risk factors identified were local infection (n=2), previous ipsilateral knee surgery (n=2), and the use of an allograft (n=1). All patients underwent emergency knee washout and debridement with graft retention within 24 hours, together with a course of intravenous antibiotic therapy. All the patients achieved eradication of their infections (with intact ACL grafts) and satisfactory functional outcome at a mean follow-up of 32 (range, 25-45) months. PMID:24781628

  6. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction.

    PubMed

    Muscolo, D Luis; Carbo, Lisandro; Aponte-Tinao, Luis A; Ayerza, Miguel A; Makino, Arturo

    2009-09-01

    Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction. PMID:19190972

  7. Diagnosis of ligamentous and meniscal pathologies in patients with anterior cruciate ligament injury: comparison of magnetic resonance imaging and arthroscopic findings

    PubMed Central

    Sayampanathan, Andrew Arjun; Koh, Thean-Howe Bryan; Tan, Hwee-Chye Andrew

    2015-01-01

    Background Magnetic resonance imaging (MRI) is routinely used to diagnose or support clinical diagnoses for meniscal or ligamentous injuries prior to offering patients arthroscopic treatment. However, the sensitivity of MRI for the detection of meniscal injury is not yet 100%. Sportsmen have occasionally returned to play with undiagnosed meniscal lesions on the basis of a normal MRI examination. This study was designed to assess the diagnostic parameters of MRI in patients with acute anterior cruciate ligament (ACL) injury. Methods MRI and arthroscopic findings of 320 patients with acute ACL injury were included in this retrospective review. Patients belonged to a single surgeon from a high volume tertiary healthcare institution. All patients had either a MRI or an arthroscopic diagnosis of an acute ACL injury of one knee or both. All patients underwent therapeutic arthroscopy by the senior author routinely as part of arthroscopy-aided ACL reconstruction. Arthroscopic findings were the diagnostic reference based on which the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and concordance strength of association of MRI were calculated for ACL, posterior cruciate ligament (PCL), medial meniscus (MM) and lateral meniscus (LM) injuries. Results MRI was most accurate in diagnosing cruciate ligament injuries with a PPV approaching 100%. The PPV of MRI in diagnosing meniscal injuries was approximately 60%. MRI was almost 100% sensitive and specific in diagnosing ACL injuries and 82% sensitive and 100% specific in diagnosing PCL injuries. Conversely, MRI was 77% sensitive and 90% specific in diagnosing MM injuries; and 57% sensitive and 95% specific in diagnosing LM injuries. Conclusions MRI remains the gold standard for diagnosing soft tissue injuries of the knee. However, there is a false positive rate ranging from 6% to 11% for meniscal tears. PMID:26605289

  8. Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

    PubMed Central

    2010-01-01

    Background The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib versus celecoxib for post-operative pain relief after arthroscopic anterior cruciate ligament reconstruction. Methods One hundred and two patients diagnosed as anterior cruciate ligament injury were randomized into 3 groups using opaque envelope. Both patients and surgeon were blinded to the allocation. All of the patients were operated by one orthopaedic surgeon under regional anesthesia. Each group was given either etoricoxib 120 mg., celecoxib 400 mg., or placebo 1 hour prior to operative incision. Post-operative pain intensity, time to first dose of analgesic requirement and numbers of analgesic used for pain control and adverse events were recorded periodically to 48 hours after surgery. We analyzed the data according to intention to treat principle. Results Among 102 patients, 35 were in etoricoxib, 35 in celecoxib and 32 in placebo group. The mean age of the patients was 30 years and most of the injury came from sports injury. There were no significant differences in all demographic characteristics among groups. The etoricoxib group had significantly less pain intensity than the other two groups at recovery room and up to 8 hours period but no significance difference in all other evaluation point, while celecoxib showed no significantly difference from placebo at any time points. The time to first dose of analgesic medication, amount of analgesic used, patient's satisfaction with pain control and incidence of adverse events were also no significantly difference among three groups. Conclusions Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction. Trial registration number NCT01017380 PMID:20973952

  9. Functional outcome in athletes at five years of arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Devgan, Ashish; Magu, N K; Siwach, R C; Rohilla, Rajesh; Sangwan, S S

    2011-01-01

    Introduction. The purpose of this study was to analyze the functional outcome in competitive level athletes at 5 years after ACL reconstruction with regard to return to sports and the factors or reasons in those who either stopped sports or showed a fall in their sporting levels. Methods. 48 competitive athletes who had undergone arthroscopic assisted ACL reconstruction with a minimum follow up of at least 5 years were successfully recalled and were analyzed. Results. 22 patients had returned to the preinjury levels of sports and 18 showed a decrease in their sporting levels. Of the 18 patients, 12 referred to fear of reinjuring the same or contra-lateral knee as the prime reason for the same while 6 patients reported persisting knee pain and instability as reasons for a fall in their sporting abilities. The difference in the scores of these groups was statistically significant. 8 patients out of the 48 had left sports completely due to reasons other than sports, even though they had good knee outcome scores. Conclusion. Fear of reinjury and psychosocial issues that are relevant to the social milieu of the athlete are very important and affect the overall results of the surgery with respect to return to sports. PMID:24977065

  10. Quantifying the problem of kneeling after a two incision bone tendon bone arthroscopic anterior cruciate ligament reconstruction

    PubMed Central

    Riaz, Osman; Nisar, Sohail; Phillips, Hannah; Siddiqui, Asim

    2015-01-01

    Summary Introduction the aims of this study was to investigate the post-operative incidence of anterior knee pain and quantify the problem of kneeling in patients who have underwent anterior cruciate ligament (ACL) reconstruction with a bone tendon bone (BTB) graft. Methods prospective study of 71 male patients who participated in competitive sports and underwent BTB ACL reconstruction using a two incision approach between August 2008 and May 2011. The patella defect was packed with bone graft, and the peritenon was preserved and repaired. A questionnaire was used to evaluate pain and kneeling capability. All patients had pre and post operative Lysholm/Tegner scores, KT1000 evaluation and hop tests to assess knee stability and function. Results 71 patients were operated and had a follow up of 42 months, mean age 29.8. 22 patients had anterior knee pain on kneeling, paraesthesia of anterior knee was found in 23 patients. 65 patients were still able to kneel and 6 found they were unable. 36 were able to kneel for unrestricted periods, 9 for 5–15 minutes, 15 kneel for 1–5 minutes and 5 for >1 minute. Anterior knee pain was compared to kneeling time (P=0.001). Paraesthesia and kneeling time, (P=0.001). Anterior knee pain when compared with Lysholm score (P=0.540), hop test (P=0.277), and Lachman’s (P=0.254). Conclusions two incision BTB grafting of the patella and repair of the paritenon minimises the length of scar at the front of the knee. This reduces any palpable defects which could be causation factor for pain whilst kneeling. We have quantified kneeling and pain, thus aiding patients and surgeons in making the right decision for graft choice for ACL reconstruction. PMID:26605192

  11. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.

  12. Anterior Cruciate Ligament Reconstruction Learning Module

    MedlinePLUS

    ... of ACL Injury Symptoms Diagnosis Nonsurgical Treatment Surgical Treatment Your Surgery After Surgery Risks and Complications Conclusion Related Topics Exit This Module Informed Patient - Anterior Cruciate Ligament Reconstruction Help Introduction Welcome to the American Academy ...

  13. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts.

    PubMed

    Valenti, J R; Sala, D; Schweitzer, D

    1994-01-01

    A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction. PMID:8002109

  14. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  15. Causes of anterior cruciate ligament injuries.

    PubMed

    Risti?, Vladimir; Ninkovi?, Srdan; Harhaji, Vladimir; Milankov, Miroslav

    2010-01-01

    In order to prevent anterior cruciate ligament injuries it is necessary to define risk factors and to analyze the most frequent causes of injuries--that being the aim of this study. The study sample consisted of 451 surgically treated patients, including 400 sportsmen (65% of them being active and 35% recreational sportsmen), 29% female and 71% male; of whom 90% were younger than 35. Sports injuries, as the most frequent cause of anterior cruciate ligament injuries, were recorded in 88% of patients (non-contact ones in 78% and contact ones in 22%), injuries occurring in everyday activities in 11% and in traffic in 1%. Among sportsmen, reconstruction of the anterior cruciate ligament was most frequently performed in football players (48%), then in handball players (22%), basketball players (13%), volleyball players (8%), martial arts fighters (4%). However, the injury incidence was the highest among the active basketball players (1 injured among 91 active players). Type of footwear, warming up before the activity, genetic predisposition and everyday therapy did not have a significant influence on getting injured. Anterior cruciate ligament injuries happened three times more often during matches, in the middle and at the end of a match and training session (79%), at landing after the jump or when changing direction of movement (75%) without a contact with other competitors, on dry surfaces (79%), among not so well prepared sportsmen. PMID:21443155

  16. Arthroscopic Reconstruction of Chronic Isolated Posterior Cruciate Ligament Instability in a Professional Dancer

    PubMed Central

    Aksu, Neslihan; Abay, Burak; Soydan, Ramazan; Ercan, Ertu?rul

    2014-01-01

    Objectives: Chronic isolated injuries of the posterior cruciate ligament (PCL) are very rare in the literature. PCL injuries are often presented undiagnosed because of the weak signs of the injury compared to the anterior cruciate ligament (ACL) injuries. We report the surgical outcome of arthroscopic reconstruction of the chronic isolated PCL rupture with ipsilateral autologous hamstring tendon in a professional Caucasian dancer. Methods: A 21-year-old male professional Caucasian dancer presented severe instability without any pain in his right knee lasting for one year. The patient did not describe any specific traumatic event but his both knees received repeatitive direct pretibial trauma during hyperflexion of the knee while landing to the floor. At the physical examination, posterior sagging of the tibia was observed on the affected side at 90o of knee flexion and step off test and posterior drawer test were positive preoperatively under general anesthesia. The Tegner Lysholm score was evaluated as 59 (poor). A magnetic resonance image (MRI) revealed the isolated total rupture of PCL. The treatment of choice was arthroscopic single bundle reconstruction of PCL with ipsilateral autologous hamstring tendon. A standard arthroscopic exploration of the joint was performed preoperatively and we didn't observe any meniscal, cartilage or ligamentous lesion. Anteromedial and anterolateral portals were made in order to visualize the posterior cortex of the tibia with a 70 degree scope. Intra-operative fluroscopy was used to confirm proper tunnel position. During postoperatively first week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. Quadriceps musculature and passive range of motion was trained. Results: At the 6 month- follow-up, the patient achieved full symmetric restoration of motion. He had returned to full daily activies. The Tegner Lysholm score was evaluated as 95 (excellent) postoperatively. Functional examination of the right knee reveled 140 of flexion, and full knee extension. No posterior sagging was observed and step off test and posterior drawer test was negative. The complaint of instability was disappeared. At 1-year follow-up, clinical findings were unremarkable, with no sign of re-rupture and he returned to his professional career. Conclusion: Surgical reconstruction technique of the PCL and associated rehabilitation protocols has not yet been fully standardized and much work still has be done optimizing correct treatment of PCL injuries. The arthroscopic reconstruction of chronic isolated PCL instability is a very difficult technique as well as its diagnosis. The reconstruction is very beneficial in the athletes and the patients who are not responding well to the conservative treatment.

  17. [Arthroscopic versus open anterior shoulder stabilization. A systematic validation].

    PubMed

    Steinbeck, J; Witt, K-A; Marquardt, B

    2009-01-01

    The treatment of traumatic anterior glenohumeral instability has been a topic of debate over the last couple of decades. However, a consensus exists regarding the necessity of an individualized treatment plan based on the type and degree of instability and the patient's functional demands. Various open and arthroscopic techniques are among the currently used surgical procedures. Open reconstruction of the capsulolabral complex had been considered the treatment of choice for many years, but the latest results for arthroscopic anterior shoulder stabilization demonstrate its increasing use. The current literature suggests that with the introduction of suture anchors, it is possible to mirror the principles of open anterior shoulder stabilization and thus combine the general advantages of arthroscopic surgery with a low recurrence rate. PMID:19093098

  18. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft

    PubMed Central

    Sun, Xiujiang; Zhang, Jianfeng; Qu, Xiaoyi

    2015-01-01

    Introduction The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. Material and methods Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. Results The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). Conclusions Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores were found. PMID:25995757

  19. Arthroscopic Bone Graft Procedure for Anterior Inferior Glenohumeral Instability

    PubMed Central

    Taverna, Ettore; D'Ambrosi, Riccardo; Perfetti, Carlo; Garavaglia, Guido

    2014-01-01

    There are many described surgical techniques for the treatment of recurrent anterior shoulder instability. Numerous authors have performed anterior bone block procedures with good results for the treatment of anterior shoulder instability with glenoid bone loss. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions with less soft-tissue dissection, better visualization of the joint, better repair accessibility, and the best possible outcome for external rotation. We describe an arthroscopic anteroinferior shoulder stabilization technique with an iliac crest tricortical bone graft and capsulolabral reconstruction. It is an all-arthroscopic technique with the advantage of not using fixation devices, such as screws, but instead using special buttons to fix the bone graft. The steps of the operation are as follows: precise placement of a specific posterior glenoid guide that allows the accurate positioning of the bone graft on the anterior glenoid neck; fixation of the graft flush with the anterior glenoid rim using specific buttons under arthroscopic control; and finally, subsequent capsular, labral, and ligament reconstruction on the glenoid rim using suture anchors and leaving the graft as an extra-articular structure. PMID:25685669

  20. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury. PMID:23016083

  1. Complications of anterior cruciate ligament reconstruction: MR imaging.

    PubMed

    Papakonstantinou, Olympia; Chung, Christine B; Chanchairujira, Kullanuch; Resnick, Donald L

    2003-05-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. PMID:12695835

  2. Osteonecrosis of the Knee After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Lansdown, Drew A.; Shaw, Jeremy; Allen, Christina R.; Ma, C. Benjamin

    2015-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction is performed commonly, with a low risk of complication. Osteonecrosis of the knee is a potentially devastating condition and has been observed both spontaneously and after meniscectomy, although osteonecrosis has not been described as a complication after ACL reconstruction. Purpose: To describe the development of osteonecrosis of the knee in 5 patients after arthroscopic ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: This study involved 5 patients (mean age, 33.2 years) who developed osteonecrosis of the knee after ACL reconstruction. A retrospective chart review was performed to identify clinical characteristics and surgical factors present in each of the 5 cases. Results: In 4 cases, the pathologic changes were present in both the medial and lateral femoral condyles, with isolated lateral condyle changes in the other case. The mean time to diagnosis was 11.6 months. These patients underwent an average of 1.8 additional surgical procedures after the diagnosis of osteonecrosis. Conclusion: Osteonecrosis of the knee is a rare outcome after ACL reconstruction. We are unable to identify clear risk factors for the development of this complication, although we hope the presentation of these cases will help promote the identification of other cases in future studies. PMID:26665035

  3. Epidemiology of anterior cruciate ligament injuries in soccer.

    PubMed

    Bjordal, J M; Arn?y, F; Hannestad, B; Strand, T

    1997-01-01

    We did a retrospective study of all anterior cruciate ligament injuries (972) verified by arthroscopic evaluation at hospitals in the Hordaland region of Norway from 1982 to 1991. Our final study group comprised 176 patients who had participated in organized soccer and answered a questionnaire. The overall incidence rate was 0.063 injuries per 1000 game hours. Men incurred 75.6% (133) of the injuries. Women had an incidence rate of 0.10 injuries per 1000 game hours, significantly higher than that for men (0.057). The incidence rate was higher (0.41) for men in the top three divisions. Most of the injuries (124) occurred during games. Contact injuries from tackling was the injury mechanism in 46.0% of the cases. Players on the offensive team incurred 122 (69.3%) of the injuries. Reconstructive surgery was performed on 131 (74.4%) of the injured players and was found necessary for return to a high level of play. Half of the players (87) returned to soccer; men at high levels of play had the highest return rate (88.9%), and men over age 34 had the poorest return rate (22.9%). Nearly one-third of the injured athletes gave up soccer because of poor knee function or fear of new injury. PMID:9167814

  4. Partial tearing of the anterior cruciate ligament: diagnosis and treatment

    PubMed Central

    Temponi, Eduardo Frois; de Carvalho Júnior, Lúcio Honório; Sonnery-Cottet, Bertrand; Chambat, Pierre

    2015-01-01

    Partial tears of the anterior cruciate ligament (ACL) are common and represent 10–27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction. PMID:26229890

  5. Revision anterior cruciate ligament reconstruction: an update.

    PubMed

    Mayr, R; Rosenberger, R; Agraharam, D; Smekal, V; El Attal, René

    2012-09-01

    With the rising number of anterior cruciate ligament (ACL) reconstructions performed, revision ACL reconstruction is increasingly common nowadays. A broad variety of primary and revision ACL reconstruction techniques have been described in the literature. Recurrent instability after primary ACL surgery is often due to non-anatomical ACL graft reconstruction and altered biomechanics. Anatomical reconstruction must be the primary goal of this challenging revision procedure. Recently, revision ACL reconstruction has been described using double bundle hamstring graft. Successful revision ACL reconstruction requires an exact understanding of the causes of failure and technical or diagnostic errors. The purpose of this article is to review the causes of failure, preoperative evaluation, graft selection and types of fixation, tunnel placement, various types of surgical techniques and clinical outcome of revision ACL reconstruction. PMID:22669543

  6. Individualized anatomic anterior cruciate ligament reconstruction.

    PubMed

    van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H

    2015-02-01

    Abstract Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities. PMID:25684559

  7. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

    2013-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

  8. Design of a novel anterior cruciate ligament prosthesis

    E-print Network

    Talei Franzesi, Giovanni

    2006-01-01

    Injuries to the anterior cruciate ligament (ACL) are extremely common (approximately 100,000 every year in the US) and result in greatly reduced mobility; although several surgical procedures have been devised to address ...

  9. Editorial Commentary: Anterior Cruciate Ligament Primary Repair, Revisited.

    PubMed

    Lubowitz, James H

    2015-11-01

    Anterior cruciate ligament (ACL) primary repair shows good results at 2-year follow-up for proximal tears with good tissue quality. History teaches us to remain cautious pending 5-year follow-up. PMID:26542202

  10. Arthroscopic anterior cruciate ligament surgery: results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft five year follow-up of a prospective randomised controlled trial.

    PubMed

    Ghalayini, S R A; Helm, A T; Bonshahi, A Y; Lavender, A; Johnson, D S; Smith, R B

    2010-10-01

    We conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). There were no significant differences between Lysholm or IKDC scores at any stage by 5 years. Significant differences were found between the groups at 2 years for Tegner activity scores, laxity and one-hop testing. By 5 years there were no significant differences. Clinical equivalence was demonstrated between the two groups for the Lysholm score and one-hop test but not for the Tegner activity score at 5 years. The use of the LK ligament has been largely abandoned due to reports of its insufficiency. Our results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present. PMID:19861236

  11. Visual biofeedback exercises for improving body balance control after anterior cruciate ligament reconstruction

    PubMed Central

    Molka, Alicja Zyta; Lisi?ski, Przemys?aw; Huber, Juliusz

    2015-01-01

    [Purpose] To evaluate the effects of balance training after arthroscopic anterior cruciate ligament reconstruction. [Subjects and Methods] Sixteen patients (mean 33 ± 8?years old) who underwent anterior cruciate ligament reconstruction three months prior to participating in a one-month rehabilitation program. The control group included 15 people aged 34 ± 4?years. Patients’ functional level was evaluated according to the Lysholm knee score, and balance quality was ascertained by static and dynamic tests. A balance platform was used to measure the center of foot pressure deflection. Two dynamic balance tests evaluated time of task execution. [Results] Lysholm knee score improved significantly after rehabilitation. Balance in the sagittal plane with eyes closed improved significantly after rehabilitation. The average velocity of center of foot pressure swing in both the frontal and sagittal planes with eyes closed differed significantly from those of controls. Execution time required for the two dynamic tests decreased significantly after rehabilitation and were significantly better than those in the controls. [Conclusion] Maintaining static balance with eyes closed is very challenging after anterior cruciate ligament reconstruction. Maintaining balance in the sagittal plane is particularly difficult. A one-month rehabilitation program partially improves static and dynamic balance. PMID:26311983

  12. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  13. Arthroscopic management of a chronic primary anterior shoulder dislocation.

    PubMed

    Galano, Gregory J; Dieter, Alexis A; Moradi, Natan E; Ahmad, Christopher S

    2010-07-01

    Chronic anterior dislocation of the glenohumeral joint often leads to functional impairment and pain. Duration of dislocation is correlated with complications, and this injury is traditionally treated with an open procedure. A right-hand - dominant woman in her late 70s presented with traumatic chronic anterior dislocation of the glenohumeral joint. Her physical exam and imaging studies were consistent with anterior shoulder dislocation, a large Hill-Sachs deformity, and rotator cuff and anterior labral tears. A shoulder reduction under anesthesia was performed followed by an arthroscopic double-row rotator cuff repair. In addition, a labral repair was performed via percutaneously inserted suture anchors. Following this treatment, stability was restored to the glenohumeral joint. The patient progressed well with physical therapy and, at 1-year follow-up, the patient had returned to all routine activities pain-free. Arthroscopic repair of chronic primary traumatic anterior shoulder dislocations requiring surgical treatment is a valuable alternative to open procedures and should be considered in higher-functioning elderly patients. Percutaneous suture anchor placement minimizes trauma to an already pathologic rotator cuff and joint capsule. PMID:20844774

  14. Arthroscopic assessment of stifle synovitis in dogs with cranial cruciate ligament rupture.

    PubMed

    Little, Jeffrey P; Bleedorn, Jason A; Sutherland, Brian J; Sullivan, Ruth; Kalscheur, Vicki L; Ramaker, Megan A; Schaefer, Susan L; Hao, Zhengling; Muir, Peter

    2014-01-01

    Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3(+) T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p<0.05). Numbers of CD3+ T lymphocytes (SR = 0.50, p<0.05) and TRAP+ cells in joint pouches (SR = 0.59, p<0.01) were correlated between joint pairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p<0.05). Arthroscopic grading of villus hypertrophy correlated with numbers of CD3(+) T lymphocytes (SR = 0.34, p<0.05). Synovial intima thickness was correlated with arthroscopic hypertrophy, vascularity, and synovitis (SR>0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy. PMID:24892866

  15. Arthroscopic Assessment of Stifle Synovitis in Dogs with Cranial Cruciate Ligament Rupture

    PubMed Central

    Little, Jeffrey P.; Bleedorn, Jason A.; Sutherland, Brian J.; Sullivan, Ruth; Kalscheur, Vicki L.; Ramaker, Megan A.; Schaefer, Susan L.; Hao, Zhengling; Muir, Peter

    2014-01-01

    Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3+ T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p<0.05). Numbers of CD3+ T lymphocytes (SR?=?0.50, p<0.05) and TRAP+ cells in joint pouches (SR?=?0.59, p<0.01) were correlated between joint pairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p<0.05). Arthroscopic grading of villus hypertrophy correlated with numbers of CD3+ T lymphocytes (SR?=?0.34, p<0.05). Synovial intima thickness was correlated with arthroscopic hypertrophy, vascularity, and synovitis (SR>0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy. PMID:24892866

  16. Arthroscopic Versus Open Stabilization for Anterior Shoulder Subluxations

    PubMed Central

    Owens, Brett D.; Cameron, Kenneth L.; Peck, Karen Y.; DeBerardino, Thomas M.; Nelson, Bradley J.; Taylor, Dean C.; Tenuta, Joachim; Svoboda, Steven J.

    2015-01-01

    Background: Most of the literature on shoulder instability focuses on patients experiencing anterior glenohumeral dislocation, with little known about the treatment of anterior subluxation events. Purpose: To determine the outcomes of surgical stabilization of patients with anterior glenohumeral subluxations and to compare open and arthroscopic approaches. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: We prospectively enrolled patients with anterior glenohumeral subluxations undergoing surgical stabilization. Patients were offered randomization between open and arthroscopic stabilization. Inclusion criteria included patients with anterior glenohumeral subluxations undergoing Bankart repair, while exclusions included the presence of glenoid or humeral bone loss, multidirectional instability, capsular tear/humeral avulsion of the glenohumeral ligament lesion, and rotator cuff tear requiring repair. Patients were randomized to an open Bankart repair through a subscapularis takedown or an arthroscopic Bankart repair, both using the same bioabsorbable suture anchors, and they were followed for a minimum of 2 years. Outcomes were evaluated with the Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Rowe, and Tegner activity scores. Results: A total of 26 patients were enrolled, with 7 being lost to follow-up. Complete follow-up data were available on 19 subjects (74%): 10 in the open group and 9 in the arthroscopic group. There were no significant differences noted between the randomized groups, with a 2-year WOSI score of 320 in the open subjects and 330 in the arthroscopic subjects, and similar findings in the other scoring scales. There were no cases of dislocation following surgery. There were 3 patients with recurrent instability (subluxations only) in each group at a mean of 17 months, for an overall recurrent subluxation rate of 31%. These subjects with recurrence had lower outcome scores (WOSI, 532; SANE, 88.4). The outcomes of the 9 subjects with ?3 subluxation events were superior to those of the 10 subjects with >3 events prior to stabilization. The patients with ?3 events had a WOSI score of 143, compared with 470 (P = .042), and an ASES mean score of 98.8, compared with 87.1 (P = .048). Four of the 6 patients with recurrent subluxations had sustained >3 subluxations prior to stabilization. Conclusion: Overall, patients with Bankart lesions resulting from an anterior glenohumeral subluxation event had excellent outcomes with surgical stabilization. The overall recurrence in the 19 subjects with at least 2-year follow-up was 6 cases (31%), with no instances of dislocation in this young, active cohort. There was no significant benefit to open or arthroscopic stabilization, and we did find that stabilization of subluxation patients with ?3 events resulted in superior outcomes compared with chronic recurrent subluxation patients with >3 events. We recommend early surgical stabilization of young athletes with Bankart lesions that result from anterior subluxation events. PMID:26535374

  17. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair.

    PubMed

    Yong, Elaine X L; Cheong, Elaine Y L; Boutlis, Craig S; Chen, Darren B; Liu, Eunice Y-T; McKew, Genevieve L

    2015-08-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis. PMID:26041900

  18. Pretibial cyst formation after anterior cruciate ligament reconstruction with a hamstring tendon autograft.

    PubMed

    Tsuda, Eiichi; Ishibashi, Yasuyuki; Tazawa, Koji; Sato, Hideki; Kusumi, Tomomi; Toh, Satoshi

    2006-06-01

    We report a case of pretibial cyst formation, which is a rare complication, after anterior cruciate ligament (ACL) reconstruction. The patient had undergone ACL reconstruction at age 18 and complained of pain and swelling localized on the anteromedial aspect of the ipsilateral proximal tibia 2 years postoperatively. Magnetic resonance imaging showed a multilocular fluid-filled cyst arising from the outlet of the tibial bone tunnel. Open resection of the cyst was performed and communication between the tibial tunnel and the joint space was confirmed arthroscopically. The cavity of the tibial tunnel was packed with cancellous bone to seal off a water channel. The laboratory examination revealed slightly concentrated chondroitin sulfate in the cyst fluid compared with the articular fluid, despite histologic observation of no glycosaminoglycan synthesis in the cells of the cyst wall. These findings indicated that leakage of the articular fluid via the tibial tunnel might have caused the pretibial cyst after ACL reconstruction. PMID:16762723

  19. Current Arthroscopic Concepts in Repairing Posterior Cruciate Ligament Tibial-Sided Avulsions.

    PubMed

    Malempati, Chaitu; Felder, Jerrod; Elliott, Michael; Brunkhorst, Joseph; Miller, Mark; Johnson, Darren L

    2015-09-01

    Posterior cruciate ligament (PCL) injuries are extremely rare and most commonly occur in the trauma setting. They can lead to instability, pain, diminished function, and eventual arthrosis. Several techniques of arthroscopic PCL repair for tibial-sided bony avulsions have been described in the literature; however, no single technique has emerged as the gold standard to predictably restore posterior knee stability, PCL function, and knee biomechanics. The authors believe that the best results will come from procedures that re-create the normal human anatomy and knee kinematics. In this article, 3 arthroscopic methods of PCL avulsion repairs performed at 2 academic institutions are analyzed. The techniques described here provide good options for the treatment of these injuries. [Orthopedics. 2015; 38(9):563-569.]. PMID:26375528

  20. Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts.

    PubMed

    Than, P; Bálint, L; Domán, I; Szabó, G

    1999-01-01

    Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response. PMID:10853785

  1. Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes.

    PubMed

    Malempati, Chaitu; Jurjans, John; Noehren, Brian; Ireland, Mary L; Johnson, Darren L

    2015-11-01

    The anterior cruciate ligament is the most commonly disrupted ligament in the knee in high-performance athletes. Most recently, advancements in surgical technique and graft fixation have enabled athletes to participate in early postoperative rehabilitation, focusing on range of motion and progressing to patellar mobilization, strengthening, and neuromuscular control. Several rehabilitation protocols exist with variations in specific exercises, progression through phases, and key components. The ultimate goal of rehabilitation is to return the athlete to preinjury performance level, including motion and strength, without injuring or elongating the graft. Each athlete is unique; thus, safe return to play should be individualized rather than follow a particular postoperative month or time line. This article provides an overview of the application and the scientific basis for formulating a rehabilitation protocol prior to and following anterior cruciate ligament surgery. [Orthopedics. 2015; 38(11):689-696.]. PMID:26558662

  2. [Injuries of the anterior cruciate ligament in athletes].

    PubMed

    Shafizadeh, S; Schneider, M M; Bouillon, B

    2014-10-01

    Anterior cruciate ligament ruptures represent serious injuries for athletes which are often associated with accompanying injuries and lead to relevant kinematic alterations in the femorotibial roll-glide mechanism of the knee joint. Instability resulting in recurrent giving way events, as well as instability-related meniscal and cartilage lesions can cause functional long-term impairment that may limit the athlete's career. Anterior cruciate ligament replacement is therefore considered to be the gold standard for recovery of physical performance and to prevent secondary meniscal and cartilage damage. Continuous changes in the reconstruction of the anterior cruciate ligament have led to a variety of different methods, including graft choice, fixation devices and surgical techniques, which support the consideration of individual requirements of the athlete as well as sport-specific aspects. One of the main factors for restoring stability and the physiological kinematic roll-glide mechanism of the knee is an anatomical tunnel placement as well as a stable graft fixation in the tibia and femur. By achieving of these fundamental technical requirements an early functional rehabilitation and accelerated recovery of neuromuscular skills, strength and coordination can be achieved, so that an early return to sport activities is possible. PMID:25225041

  3. Bone tunnel enlargement on anterior cruciate ligament reconstruction

    PubMed Central

    Leonardi, Adriano Barros de Aguiar; Duarte, Aires; Severino, Nilson Roberto

    2014-01-01

    Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

  4. Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management

    PubMed Central

    Aydin, Nuri; Sirin, Evrim; Arya, Alp

    2014-01-01

    After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management. PMID:25035838

  5. A long-term study of anterior cruciate ligament allograft reconstruction.

    PubMed

    Almqvist, K F; Willaert, Pieter; De Brabandere, S; Criel, K; Verdonk, R

    2009-07-01

    We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females) were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months. All patients were examined by an independent examiner. Seven patients had an extension lag (<5 degrees) and all patients had a knee flexion of at least 120 degrees, with a mean flexion of 135 +/- 5 degrees compared to 135 +/- 8 degrees. At the time of follow-up, the median IKDC score was 97 (74-100). The Lysholm scoring scale had a median value of 95 (76-100). The median sports level on the Tegner scale was 6 (4-9). The one-leg-hop test showed a mean value of 95 +/- 5%. One patient did not perform the one-leg-hop test because of recent surgery to the Achilles tendon. In conclusion, the tibialis anterior or tibialis posterior tendon allograft ACL reconstruction produced good clinical results in the majority of patients at long-term follow-up. PMID:19421736

  6. Magnetic Resonance Imaging of Complications of Anterior Cruciate Ligament Reconstruction.

    PubMed

    Dayan, Etan; Maderazo, Alex; Fitzpatrick, Darren

    2015-12-01

    The incidence of anterior cruciate ligament reconstruction (ACL-R) has increased in recent years. ACL-R plays an important role in the prevention of secondary osteoarthritis from resultant joint instability. Magnetic resonance imaging is the preferred modality in the evaluation of ACL-R complications. Complications after ACL-R may be broadly characterized as those resulting in decreased range of motion (arthrofibrosis, impingement) and resulting in increased laxity (graft disruption). Other miscellaneous complications that do not fall into these categories will also be discussed in this article. PMID:26665245

  7. Prevention of anterior cruciate ligament injury in the female athlete

    PubMed Central

    Silvers, Holly Jacinda; Mandelbaum, Bert R

    2007-01-01

    The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism of ACL injury and the most effective intervention for decreasing ACL injuries in this high?risk population. PMID:17609222

  8. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

    PubMed Central

    Williams, John; Hutt, Jonathan; Rickman, Mark

    2015-01-01

    This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS). The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS). There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario. PMID:26221555

  9. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    PubMed Central

    Keyhani, Sohrab; Vaziri, Arash Sharafat; shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  10. Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction.

    PubMed

    Barber, F A; McGuire, D A; Click, S

    1998-03-01

    This prospective, randomized study evaluated continuous-flow cold therapy for postoperative pain in outpatient arthroscopic anterior cruciate ligament (ACL) reconstructions. In group 1, cold therapy was constant for 3 days then as needed in days 4 through 7. Group 2 had no cold therapy. Evaluations and diaries were kept at 1, 2, and 8 hours after surgery, and then daily. Pain was assessed using the VAS and Likert scales. There were 51 cold and 49 noncold patients included. Continuous passive movement (CPM) use averaged 54 hours for cold and 41 hours for noncold groups (P=.003). Prone hangs were done for 192 minutes in the cold group and 151 minutes in the noncold group. Motion at 1 week averaged 5/88 for the cold group and 5/79 the noncold group. The noncold group average visual analog scale (VAS) pain and Likert pain scores were always greater than the cold group. The noncold group average Vicodin use (Knoll, Mt. Olive, NJ) was always greater than the cold group use (P=.001). Continuous-flow cold therapy lowered VAS and Likert scores, reduced Vicodin use, increased prone hangs, CPM, and knee flexion. Continuous-flow cold therapy is safe and effective for outpatient ACL reconstruction reducing pain medication requirements. PMID:9531122

  11. Knee extension and flexion: MR delineation of normal and torn anterior cruciate ligaments

    SciTech Connect

    Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji

    1996-03-01

    Our goal was to assess the effect of joint position of semiflexed and extended knees in MR delineation of the anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semiflexed position (average 45{degrees} of flexion) within the magnet bore. Sets of oblique sagittal MR images were obtained for both extended and flexed knee positions. Thirty-two knees with intact ACLs and 43 knees with arthroscopically proven ACL tears were evaluated. Two observers compared paired MR images of both extended and flexed positions and rated them by a relative three point scale. Anatomic correlation in MR images was obtained by a cadaveric knee with incremental flexion. The MR images of flexed knees were more useful than of extended knees in 53% of the case reviews of femoral attachments and 36% of reviews of midportions of normal ACLs. Compared with knee extensions, the MR images for knee flexion provided better clarity in 48% of reviews of disrupted sites and 52% of residual bundles of torn ACLs. Normal ACL appeared taut in the knee extension and lax in semiflexion. Compared with MR images of knees in extension, MR images of knees in flexion more clearly delineate the femoral side of the ligament with wider space under the intercondylar roof and with decreased volume-averaging artifacts, providing superior visualization of normal and torn ACLs. 13 refs., 7 figs., 1 tab.

  12. Management of anterior cruciate ligament tears in skeletally immature athletes.

    PubMed

    Ludwig, Meryl; Atanda, Alfred

    2015-11-01

    The prevalence of anterior cruciate ligament (ACL) injuries in skeletally immature athletes has increased dramatically over the past decade. Many attribute this to increased training, single-sport specialization and year-round competitive play. ACL injuries most commonly occur in athletic activities that involve cutting, pivoting, jumping and landing. Non-operative treatment consisting of activity modification, physical therapy and specialized bracing may have a role; however, recent data suggest that this may not be optimal in young, active patients. Surgical treatment has become more favorable, specifically for athletes with aspirations of higher-level sports participation. To minimize growth plate disturbances and potential for limb malalignment, the patient's skeletal age, pubertal status and remaining growth potential must be taken into consideration. We provide a review on how to evaluate, manage and treat the skeletally immature athlete with an ACL injury. PMID:26329291

  13. [Return to sport after anterior cruciate ligament reconstruction].

    PubMed

    Martin, R; Gard, S; Besson, C; Ménétrey, J

    2013-07-17

    Despite continuous advances in techniques for anterior cruciate ligament reconstruction (ACLR), return to play (RTP) after surgery remains a challenge. More than one-third of the patients are unable to return to their preinjury sport level, for most because of a fear to sustain another injury. And when a RTP is attempted, up to 20% will tear their graft and a similar % will sustain an ACL tear on the opposite side. We believe that these failures result from an incomplete recovery. Based on a literature review and on our experience, we suggest 6 objective criteria to allow a safer RTP. They rely on laxity, strength, neuromuscular function, and psychological evaluations. Rehabilitation after ACLR should focus on the deficits identified by these tests and on they specific needs of the sport that the athlete plans to return to. PMID:23971328

  14. A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

    ERIC Educational Resources Information Center

    Weesner, Carol L.; And Others

    1986-01-01

    The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

  15. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

    PubMed Central

    Vaishya, Raju; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  16. In-vivo Anterior Cruciate Ligament Elongation in Response to Axial Tibial Loads

    E-print Network

    Gill, Thomas J.

    Background: The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated ...

  17. Estimation of in-vivo forces within Anterior Cruciate Ligament in response to increased weightbearing

    E-print Network

    Hosseini, Ali, M. Eng. Massachusetts Institute of Technology

    2010-01-01

    The knowledge of Anterior Cruciate Ligament (ACL) forces in-vivo is instrumental for understanding ACL injury mechanisms and for improvement of surgical ACL reconstruction. The goal of this thesis was to develop and implement ...

  18. Tissue engineering the anterior cruciate ligament : a regenerative medicine approach in orthopaedic surgery

    E-print Network

    Canseco, José Antoni

    2013-01-01

    Anterior cruciate ligament (ACL) injuries affect over 200,000 Americans yearly, and many occur in young athletes. Current treatment options include tendon autografts and cadaveric allografts. However, these approaches often ...

  19. Treatment of Anterior Cruciate Ligament Injuries by Major League Soccer Team Physicians

    PubMed Central

    Farber, Joseph; Harris, Joshua D.; Kolstad, Kaare; McCulloch, Patrick C.

    2014-01-01

    Background: The treatment and rehabilitation procedures of anterior cruciate ligament (ACL) injuries in elite soccer players are controversial. Points of debate include surgical timing, technique, graft choice, rehabilitation, and return-to-sport criteria and timing. Purpose: To identify practice preferences among current Major League Soccer (MLS) team orthopaedic surgeons for ACL injuries. Study Design: Cross-sectional study; Level of evidence, 4. Methods: The survey was administered at the MLS team physician annual meeting in January 2013. At least 1 orthopaedic surgeon representative from each of the 19 clubs (16 from the United States, 3 from Canada) was in attendance. Teams with more than 1 affiliated orthopaedic surgeon were given an additional survey to be completed either at the meeting or returned via e-mail. Descriptive statistics, Wilcoxon Mann-Whitney (return-to-play parameters, running, and ball drills), and Fisher exact tests (graft selection, bracing, continuous passive motion) were applied to the various data sets from the survey responses. Results: A 100% survey participation rate was achieved (22 team orthopaedic surgeons representing 19 MLS teams). A single-incision, arthroscopically assisted, single-bundle reconstruction was the most common technique (91%). Surgeons were split regarding femoral tunnel drilling (50% transtibial, 46% accessory medial). Autograft bone–patellar tendon–bone (BPTB) was the most common preferred graft choice (68%). The biggest concerns about BPTB autograft and hamstring autograft were anterior knee pain (76%) and hamstring weakness (46%), respectively. Most surgeons did not recommend postoperative continuous passive motion (64%) or functional bracing (68%). Most surgeons permitted return to sport without restrictions at 6 to 8 months following surgery (82%). Surgeons who routinely used functional bracing after ACL surgery more frequently used hamstring autograft than those who used BPTB autograft (P = .04). Conclusion: This article successfully describes current management of ACL injuries among MLS team orthopaedic surgeons. The preference for single-bundle BPTB autograft is similar to published data in the National Football League and National Basketball Association. PMID:26535286

  20. Correlation between trochlear dysplasia and anterior cruciate ligament injury.

    PubMed

    Botchu, Rajesh; Obaid, Haron; Rennie, W J

    2013-08-01

    PURPOSE. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury METHODS. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/ disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. RESULTS. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76-1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non-type-A knees (p=0.023). CONCLUSION. Dejour type-A trochlear dysplasia was associated with ACL injuries. PMID:24014781

  1. Importance of Restricting Sportive Activity and Time from Injury to Surgery in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ercin, Ersin; Gokhan Bilgili, M; Atbasi, Zafer; Tanriverdi, Bulent; Hakan Basaran, S; Kural, Cemal

    2015-01-01

    Objectives : It is unclear that how long reconstruction may be delayed before additional intraarticular injuries occur. Our aim was to determine the relationship of time period from injury to surgery with the incidence of meniscal and chondral injuries recorded at the time of surgical treatment for ACL tears. The effect of sportive activity restriction, grade of chondral lesions and their locations were also evaluated Patients and Methods : 213 patients who underwent arthroscopic anterior cruciate ligament reconstruction were evaluated retrospectively. Data were analyzed for association between time period before surgery and patients sportive activity restriction with rates of meniscal and chondral injuries. According to time from initial trauma to surgery less than 12 months grouped as group I (101 patients) and 12 months and longer defined as group II (81 patients). Patients who had surgery before 12 months were divided into groups of smaller time scales (0 to 3 months, 4 to 6 months, 7 to 9 months, 10 to 12 months) to examine the relationships more closely. For sportive activity restriction a functional scale was used that described restricted activities including military training. Results : One hundred eighty-two patients were included to the study. 81 patients restricted sportive activity before surgery. 18 (% 22.2) of these patients had chondral injury [6 (% 33.3) operated before 12 months and 12 (% 66.7) operated after 12 months]. The difference was statistically significant (p=0,005). 81 patients (group II) were operated after 12 months. There were 44 (% 54.3) patients with chondral injury in this group [32 (% 72.7) patients were who continued their sportive activity and 12 (% 27.3) patients who restricted their sportive activity]. The difference was statistically significant (p=0,026). Correlation analysis showed that with increasing time from initial trauma to surgery chondral lesion incidence and grade of these lesions increases (p<0,001, p=0,001). Conclusion : The results indicate that the prolonged time from injury to surgery and continuing sportive activity before surgery increases the incidence of the chondral lesions. Also, time limit of 12 month is important to prevent chondral injury in anterior cruciate ligament reconstruction. PMID:26401168

  2. Bioabsorbable expansion bolt fixation in anterior cruciate ligament reconstruction.

    PubMed

    Piltz, S; Steinbauer, T; Meyer, L; Plitz, W; Andress, H J; Lob, G

    2004-01-01

    The current study evaluated initial fixation strength of a bioabsorbable expansion bolt compared with interference screw fixation in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Thirty calf tibial plateaus with adjacent patella and extensor ligaments were used. Bioabsorbable poly-L-lactide interference screws were used for graft fixation in Group I, titanium screws in Group II, and bioabsorbable poly-DL-lactide expansion bolts were used in Group III. The mean force-to-failure (+/- standard deviation) in the three groups was 487 +/- 205 N, 713 +/- 218 N, and 594 +/- 224 N, respectively. The differences between Groups I and II were significant. No statistical differences were found regarding stiffness. Graft damage was significantly less in Group III compared with screw fixation. The fixation concept of an expansion bolt shows similar fixation strength and less graft damage compared with the established interference screw fixation. Because of the total absence of torque forces in contrast to bioabsorbable screws, the risk of implant breakage is minimized. PMID:15043122

  3. Rehabilitation After Anterior Cruciate Ligament Reconstruction in the Female Athlete

    PubMed Central

    Wilk, Kevin E.; Arrigo, Christopher; Andrews, James R.; Clancy, William G.

    1999-01-01

    Objective: To discuss the rehabilitation program after anterior cruciate ligament (ACL) reconstruction in the female athlete. In addition, we will discuss 8 unique characteristics identified in the female athlete and specific training drills to address and correct the potentially deleterious effects of these unique characteristics. Background: The female athlete appears to be more susceptible to noncontact ACL injuries than the male athlete. There seem to be many differences between the female and male athlete that may contribute to the increased injury rate in the female athlete. These variations include anatomical and neuromuscular considerations and differences. Description: Based on the unique characteristics of the female athlete and the anatomical and neuromuscular dissimilarities, a specially designed rehabilitation program has been established for the female athlete after ACL surgery. Clinical Advantages: The rehabilitation drills discussed in this article challenge the neuromuscular system through proprioception, kinesthesia, dynamic joint stability, neuromuscular control, and perturbation training activities. Improving the female athlete's neuromuscular system will, we believe, expedite the injured athlete's recovery after ACL injury or surgery. Although the concepts discussed are part of a postoperative rehabilitation program after ACL surgery, these concepts may also be implemented as a preventive program to assist in reducing the incidence of ACL injuries in the female athlete. ImagesFigure 1.Figure 2.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13.Figure 14.Figure 15.Figure 16.Figure 17.Figure 18.Figure 19.Figure 20.Figure 21.Figure 22.Figure 23. PMID:16558561

  4. Basic science of anterior cruciate ligament injury and repair

    PubMed Central

    Kiapour, A. M.; Murray, M. M.

    2014-01-01

    Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20–31. PMID:24497504

  5. Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure?

    PubMed Central

    de Vasconcelos, Diego Protásio; de Paula Mozella, Alan; de Sousa Filho, Pedro Guilme Teixeira; Oliveira, Gustavo Cardilo; de Araújo Barros Cobra, Hugo Alexandre

    2015-01-01

    Objective To make a comparative analysis on three femoropatellar radiographic parameters, between knees with chronic failure of the anterior cruciate ligament (ACL) and normal knees. Methods Thirty volunteer patients with a diagnosis of unilateral isolated chronic ACL injury for more than one year and a normal contralateral knee were selected. Digital radiographs were produced for all the patients, on both knees in absolute lateral view at 30° of flexion, with and without load-bearing on one leg, and in axial view of the patella at 30°. The Caton–Deschamps patellar height index, Merchant patellar congruence angle and Laurin lateral patellar tilt angle were measured on the radiographs obtained from the normal knees and knees with ACL injuries, and comparative analysis was performed between these two groups. Results The patellar height was statistically significantly lower (p < 0.001) in the knees with ACL failure than in the normal knees, both on radiographs without loading and on those with single-foot loading. The Merchant patellar congruence angle was significantly smaller (p < 0.001) in the normal knees and the lateral patellar tilt angle was smaller (p < 0.001) in the knees with ACL failure. Conclusion Chronic ACL failure gave rise to a statistically significant change in the femoropatellar radiographic values studied (p < 0.001). Knees with injuries to this ligament presented lower patellar height values, greater tilt and lateral displacement of the patella, in relation to the femoral trochlea, in comparison with the normal contralateral knees. PMID:26229895

  6. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    PubMed

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts. PMID:1389780

  7. Kinesiophobia and Return to Sports After Anterior Cruciate Ligament Reconstruction.

    PubMed

    Medvecky, Michael J; Nelson, Stephen

    2015-03-01

    Anterior cruciate ligament (ACL) reconstruction is typically recommended for patients who wish to return to aggressive athletic activity. Unfortunately, reconstructive knee surgery is not a guarantee that all patients will return to their preinjury level of function. A recent meta-analysis including 48 studies showed that after a mean follow-up of 41 months, 82% of participants had returned to some kind of athletic activity but only 63% returned to their preinjury level of participation and a disappointing 44% returned to competitive sports. The reasons why some athletes have been unsuccessful in returning to previous levels of activity are vast and our understanding of these factors is limited. The importance of psychological factors has recently been emphasized. One such factor, kinesiophobia, or fear of reinjury, may play a significant role in some patients' inability to successfully return to their previous level of sports participation. In the meta-analysis, kinesiophobia was the most common reason cited for postoperative reduction in, or cessation of, sports participation. PMID:26244221

  8. Kinesiophobia Following Anterior Cruciate Ligament Reconstruction Among Physically Active Individuals.

    PubMed

    Cozzi, Arika L; Dunn, Kristina L; Harding, Josie L; Valovich McLeod, Tamara C; Welch, Cailee E

    2014-10-30

    There are approximately 200,000 anterior cruciate ligament (ACL) tears reported annually in the United States. Patients who undergo ACL reconstruction followed by an aggressive rehabilitation protocol can often structurally and functionally progress to a pre-injury level. Despite physical improvements with ACL rehabilitation protocols however, there are still a substantial number of individuals that do not return to pre-injury level. Particularly among physically active individuals, only 63% of patients return back to their full potential pre-injury level. This may be due to continued pain, swelling, stiffness, and weakness in the knee. Additionally, research concerning the topic of kinesiophobia (ie, fear of re-injury), which may prevent individuals from returning to their activities, has increased over the past several years. Kinesiophobia is defined as the irrational or debilitating movement of physical activity resulting in the feeling of vulnerability to painful injury or re-injury. Kinesiophobia may have a significant impact on physically active individuals, considering the amount of patients that do not return to their sport. However, it is unknown whether kinesiophobia is associated with patients' perceived physical impairment levels following ACL reconstruction. PMID:25365598

  9. Is Anterior Cruciate Reconstruction Superior to Conservative Treatment?

    PubMed

    Dawson, A G; Hutchison, J D; Sutherland, A G

    2016-01-01

    Not all patients who have a rupture of the anterior cruciate ligament (ACL) elect to have surgical reconstruction. The aim of this study was to assess the short-to-medium-term results of patients who chose conservative management in comparison to patients who had reconstructive surgery within the same time period. Sixty-three patients with an ACL injury were retrospectively studied. Forty patients were managed, according to patient choice, with ACL reconstruction and 23 conservatively. Four validated questionnaires were used to assess general and knee-specific function in a cohort with a median age of 32 years and a median follow-up period of 38 months. Patients were matched on demographic variables except for gender. There were no statistically significant differences in the outcome measures, and the majority of patients would proceed with the same treatment in the event the control leg became injured. Patients who elect to have conservative management of an ACL rupture can achieve similar function and satisfaction to those who elect to have reconstruction. Until a large randomized controlled trial is conducted, patients need to be made aware of the merits of both management strategies and the lack of evidence of superiority of one over the other. PMID:25438034

  10. Ring-shaped lateral meniscus with hypoplasic anterior cruciate ligament.

    PubMed

    Esteves, Cátia; Castro, Ricardo; Cadilha, Rui; Raposo, Frederico; Melão, Lina

    2015-12-01

    Knee joint lesions can be solitary or occur concomitantly with other lower limb abnormalities. Ring-shaped lateral meniscus (RSM) and hypoplasic anterior cruciate ligament (ACL) are two rare malformations. The therapeutic management of such abnormalities is not consensual, and highly depends on clinical symptomatology. We report a case of a 25-year-old girl with progressive knee pain whose MRI demonstrated a continuous segment of lateral meniscus situated along the medial aspect of the lateral compartment, continuous with the otherwise normal-appearing lateral meniscus, compatible with an RSM. This anatomic variant can be mistaken by a displaced meniscal fragment, like a bucket-handle tear, a central tear of a discoid meniscus, or incomplete discoid meniscus, as previously reported. Her MRI examination also showed a thinned ACL with anomalous lateral course. This abnormality may be mistaken for an ACL rupture and/or a meniscofemoral ligament with agenesis of ACL. Multiple images in different planes as well as following the course of meniscal and ligaments are critical clues to avoid misdiagnosis. As a result, the diagnosis of an RSM along with hypoplasic ACL with abnormal attachment was assumed based on MRI and confirmed during arthroscopy. The patient was treated conservatively with clinical outcome improvement. PMID:26178136

  11. Comparison of different routes of administration of clonidine for analgesia following anterior cruciate ligament repair

    PubMed Central

    Sahni, Neeru; Panda, Nidhi B; Jain, Kajal; Batra, Yatinder Kumar; Dhillon, Mandeep Singh; Jagannath, Pushpa

    2015-01-01

    Background and Aims: A high percentage of patients undergoing arthroscopic repairs on day care basis complain of inadequate postoperative pain relief. Clonidine was evaluated for the best route as an adjuvant in regional anesthesia in anterior cruciate ligament (ACL) repair to prolong analgesia. Material and Methods: A prospective randomized double-blinded study was planned in a tertiary care hospital in North India in which 85 American Society of Anesthesiologists I and II patients undergoing ACL repair were enrolled. All groups received 0.5% hyperbaric bupivacaine intrathecally as in control group C. Group IT received intrathecal 1 ?g/kg of clonidine along with hyperbaric bupivacaine, group IA received 0.25% bupivacaine and 1 ?g/kg clonidine intra-articularly, and group NB received 0.25% bupivacaine and 1 ?g/kg clonidine in femoro-sciatic nerve block (FSNB). Postoperative pain free interval and block characteristics were the primary outcomes studied. Results: Pain-free duration was 546.90 (±93.66) min in group NB (P < 0.001) in comparison to 234.90 (±20.99), 367.80 (±47.40) and 172.20 (±54.82) min in groups IA, IT and C, respectively. Sensory block and motor blockade in NB were 474.90 (±43.80) and 267.40 (±34.59) min, respectively, and were significantly prolonged (P > 0.001) in comparison to other groups. The mean rescue analgesic requirement and cumulative frequency of rescue analgesia were least in group NB, followed by groups IT, IA and C. Conclusion: Clonidine is safe and effective adjuvant with bupivacaine in prolonging analgesia through various routes employed for post knee surgery pain. The maximum prolongation of analgesia is achieved through FSNB with a risk of prolonging postanesthesia care unit stay. PMID:26702206

  12. Long-term Outcomes After Anterior Cruciate Ligament Reconstruction in Patients 60 Years and Older

    PubMed Central

    Baker, Champ L.; Jones, Jaclyn C.; Zhang, Jeff

    2014-01-01

    Background: Studies evaluating the benefit of surgical reconstruction of the anterior cruciate ligament (ACL) in middle-aged patients have shown promising results, but study populations were limited primarily to patients who were 40 to 60 years old. Some authors have suggested that surgery may benefit these older patients. Hypothesis: Patients aged ?60 years with functional instability after ACL injury would benefit from ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Medical records from 1984 through 2010 were searched for patients aged ?60 years who had undergone primary arthroscopic ACL reconstruction at a single institution. Fifteen patients (15 knees) were identified as meeting the above criteria. All patients were contacted for a telephone interview, and they completed Short Form–36 and modified Cincinnati Knee Score forms. One patient was deceased, and 1 had undergone revision to total knee arthroplasty. Among the remaining 13 patients, the mean age at surgery was 63.5 years (range, 60-73 years), and the mean patient age at the time of follow-up was 73 years (range, 65-85 years). Preoperative radiographs showed no obvious evidence of arthritis in 10 (77%) of the 13 patients; small osteophytes without loss of joint space were seen in 3 (23%) patients. The mean length of follow up was 115.7 months (range, 53-193 months). Results: At their last clinic visits, all 13 patients had regained full range of motion and returned to sports or exercise, such as tennis, golf, gym exercise, and yoga. Twelve patients reported no joint laxity. Conclusion: Patients aged ?60 years with symptomatic instability from ACL injury can have good to excellent subjective outcomes with surgical reconstruction. Clinical Relevance: Physicians who treat active patients older than 60 years should not exclude ACL reconstruction based on the patient’s age alone. PMID:26535289

  13. Early outcome of arthroscopic Bankart's repair for recurrent traumatic anterior shoulder instability

    PubMed Central

    Saccomanni, Bernardino

    2013-01-01

    Background/objectives Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery. The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2005–2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates. PMID:26403552

  14. Ultrastructure of the three anterior cruciate ligament bundles.

    PubMed

    Suzuki, Daisuke; Otsubo, Hidenori; Watanabe, Takafumi; Kamiya, Tomoaki; Nagoya, Satoshi; Yamashita, Toshihiko; Shino, Konsei

    2015-10-01

    The anterior cruciate ligament (ACL) can be morphologically separated into not only two, but three bundles: the anteromedial-medial bundle (AM-MB), the anteromedial-lateral bundle (AM-LB), and the posterolateral bundle (PLB). Our hypothesis was that the three bundles differ in their microstructures. The purpose of this study was to clarify the microstructural differences among the three bundles. The normal ACLs of six fresh frozen cadavers were harvested. After the AM-MB, AM-LB, and PLB were identified, their fibril structures were analyzed using a transmission electron microscope. The fibril orientation, distribution pattern, and the mass average diameter of the fibrils (MAD) were compared among the AM-MBs, AM-LBs, and PLBs. The AM-MB and AM-LB fibrils were arranged mostly in the longitudinal direction, while the PLB fibrils were not aligned in a uniform direction. The fibril diameter distribution pattern of AM-MBs showed a bi-modal pattern due to the existence of small-diameter (30-40 nm) and large-diameter fibrils (70-80 nm), while that of the AM-LBs and PLBs had a unimodal pattern with one prominent high peak at a diameter of 50-60 nm. The mean MAD of the AM-MBs (83.2?-?11.2 nm) was significantly larger than that of the PLBs (66.8?-?7.7 nm), while it showed no significant difference compared to that of the AM-LBs (77.6?-?12.3 nm). The three ACL bundles have different ultrastructures. The AM-MB predominantly includes thick, uni-directionally oriented fibrils like tendons, while the PLB consists of thinner, multi-directionally oriented fibrils. The AM-LB shows an intermediate structure between the AM-MB and the PLB. PMID:26118465

  15. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System

    PubMed Central

    Fitzgerald, Judd; Saluan, Paul; Richter, Dustin L.; Huff, Nathan; Schenck, Robert C.

    2015-01-01

    Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved reproduction of the femoral footprint and facilitates drilling of the femoral tunnel in an anatomic position. The use of the FAMP and straight reamer systems introduces its own set of potential complications, including short femoral tunnels and peroneal nerve injury. These potential complications have been addressed by drilling the femoral tunnel in a hyperflexed position, which can lead to difficulty with positioning the operative extremity, visualization, and identification of anatomic landmarks. The purpose of this case report was to review the advantages and technical aspects of using a flexible reamer system and the FAMP to achieve an anatomic ACL reconstruction while avoiding potential complications and pitfalls. Flexible reamer systems allow an additional way of uncoupling the tibial and femoral tunnels to clearly visualize and establish an anatomic starting point within the femoral footprint of the native ACL while avoiding the complications associated with knee hyperflexion and straight reamers with the far anteromedial portal. In the authors’ experience, an anatomic reconstruction of the ACL can be achieved safely using flexible reamers while avoiding some of the difficulties seen with straight reamers used in conjunction with an uncoupled, far anteromedial approach. PMID:26673860

  16. Establishment of a rat model for osteoarthritis resulting from anterior cruciate ligament rupture and its significance

    PubMed Central

    OUYANG, XIAO; WANG, JIAN; HONG, SHI DONG; XIN, FENG; WANG, LIN; YANG, XIAO WEI; WANG, JING RONG; WANG, LI MING; WEI, BO; WANG, QING; CUI, WEI DING

    2015-01-01

    The purpose of this study was to examine the establishment of a model concerned with osteoarthritis resulting from the anterior cruciate ligament rupture of rats and investigate the associated mechanism, as well as provide a theoretical basis for clinical treatment of the disease. Forty Sprague-Dawley male rats were randomly divided into two groups of 20 rats each and the anterior cruciate ligament transaction model and knee joint brake model were successfully established. Two rats in the anterior cruciate ligament transection group (10%) and 3 rats in the knee joint brake group (15.0%) died. The survival rate of the two groups was not statistically significant (?2<0.001, P=1.000). Swelling of the knee joint and synovium of rats in the two experimental groups was aggravated. The Mankin score was significantly higher in the anterior cruciate ligament transection group than that in the experimental group and the difference was statistically significant (P<0.05). By contrast, no significant difference was observed for osteoarthritis severity for the two experimental groups (P>0.05). Analysis of the subgroups showed that the proportion of the anterior cruciate ligament in the experimental group was significantly higher than that of the knee joint brake group, and the difference was statistically significant (P<0.05). By contrast, the difference was not statistically significant in the comparison of the medium and early proportion (P>0.05). The content of protein polysaccharide and II collagen fiber in the experimental group of the anterior cruciate ligament transection was lower than that of the knee joint brake group, and this difference was statistically significant (P<0.05). Thus the mechanism of osteoarthritis may be associated with the decrease in the content of protein and II collagen fibers. PMID:26668592

  17. Arthroscopic Remplissage for Engaging Hill-Sachs Lesions in Patients With Anterior Shoulder Instability

    PubMed Central

    Camp, Christopher L.; Dahm, Diane L.; Krych, Aaron J.

    2015-01-01

    Anterior shoulder instability is often accompanied by a Hill-Sachs defect on the humeral head that can contribute to recurrent instability if not addressed at the time of surgery. We describe a method of performing arthroscopic remplissage to treat engaging Hill-Sachs lesions in patients with glenohumeral instability. It has the benefits of being an efficient procedure that can be performed with minimal technical difficulty and can be used to augment other stabilization procedures such as labral repair. The indications for this technique include the presence of an engaging Hill-Sachs defect in patients will little or no glenoid bone loss. In appropriately selected patients, arthroscopic remplissage has shown reduced rates of recurrent instability. PMID:26697311

  18. Symmetric limb overgrowth following anterior cruciate ligament reconstruction in a skeletally immature patient.

    PubMed

    Zimmerman, Lance J; Jauregui, Julio J; Riis, Jacob F; Tuten, Hans Robert

    2015-11-01

    This report describes a case of symmetric femoral and tibial overgrowth of 2.8?cm in a 13-year-old patient after undergoing reconstruction surgery for his torn right anterior cruciate ligament. A literature review of previous cases is also provided. Following a pediatric anterior cruciate ligament tear, delaying surgery until the patient approaches skeletal maturity may avoid long-term growth disturbances, however, delaying this procedure may increase the probability of further joint damage. This growth disturbance was managed with a percutaneous epiphysiodesis that corrected the limb length deformity. PMID:25919804

  19. Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

    NASA Astrophysics Data System (ADS)

    Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

    2008-09-01

    This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

  20. Anterior Medial Meniscal Root Tears: A Novel Arthroscopic All Inside Repair

    PubMed Central

    Osti, L.; Del Buono, A.; Maffulli, N.

    2015-01-01

    Background Management of tears of the anterior and posterior roots of the meniscus is still controversial. We wish to propose a simple technique of suture anchor to repair tears of the anterior root of the medial meniscus. Methods Twelve patients, active males, underwent arthroscopic repair of the anterior meniscal horn between 2009 and 2011. All were assessed postoperatively at an average follow-up of 1 year after the index operation. Results At the last appointment, the average Lysholm scores was improved from a pre-operative average value of 48±17 to a postoperative value of 91±7 (P<0.001); five patients (45.3%) were scored as excellent (?95), and 7 (54.6%) as good (85–94). At the last appointment, 8 of 9 active patients practiced sport at the same preoperative level, 1 (8.5%) had changed to lower level of activity. No technique related complications were evident. PMID:26535186

  1. Trends in Anterior Cruciate Ligament Reconstruction in the United States

    PubMed Central

    Buller, Leonard T.; Best, Matthew J.; Baraga, Michael G.; Kaplan, Lee D.

    2014-01-01

    Background: The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee for which surgery is performed. United States national estimates of ACL reconstruction vary widely. Purpose: This study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the utilization of inpatient and ambulatory surgery for ACL tears in the United States. Study Design: Descriptive epidemiology study. Methods: The National Survey of Ambulatory Surgery, conducted in 1994, 1995, 1996, and 2006 (data from 1994, 1996, and 2006 were used in the study), and the National Hospital Discharge Survey, conducted between 1990 and 2007, were used to identify cases of ACL reconstruction. The data were analyzed for trends in demographics, treatment, and utilization. Results: Between 1994 and 2006, the population-adjusted estimate of the rate of ACL reconstructions increased by 37% (33.0/100,000 capita or 86,837 total procedures to 45.1/100,000 capita or 134,421 total procedures). There was an increase in the proportion of females undergoing reconstruction in both the ambulatory (30% to 40%) and inpatient (29% to 47%) settings over the study period, with a 304% increase in the sex-adjusted estimate of the rate of female ambulatory procedures between 1994 and 2006. Age-adjusted estimates of the rates of ambulatory ACL reconstruction increased among all age groups, with a 924% increase in patients less than 15 years of age. Concurrent meniscectomy remained relatively constant in the ambulatory (37% to 40%) and inpatient (37% to 33%) settings between 1994 and 2007. Private insurance was the largest compensator, representing 77% of cases in 2006. Between 1994 and 2006, the use of peripheral nerve blocks during ambulatory surgery increased from 0.7% to 30.8%. Conclusion: The rate of ACL reconstruction increased dramatically between 1990 and 2007 based on the National Survey of Ambulatory Surgery and National Hospital Discharge Survey databases, which represents the most up-to-date publicly available data. Knowledge of this increase and national practice patterns may aid policy makers and surgeons in appropriately allocating health care resources to ensure quality patient care. PMID:26535368

  2. The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee.

    PubMed

    Wroble, R R; Grood, E S; Cummings, J S; Henderson, J M; Noyes, F R

    1993-01-01

    We measured the increases in tibiofemoral motion when lateral structures were sectioned in anterior cruciate ligament-deficient knees of 20 unembalmed cadaveric whole lower limbs. Motion was measured with a six degrees-of-freedom electrogoniometer. The lateral structures investigated were the iliotibial band and mid-lateral capsule, lateral collateral ligament, and popliteus tendon and the posterolateral capsule. Cutting the anterolateral structures increased anterior translation and internal rotation, particularly in flexion. Increases in motions were highly variable, reflecting the variation in function in the lateral collateral ligament and posterolateral structures. Cutting the lateral collateral ligament produced small changes in anterior translation and external rotation and larger increases in adduction. Cutting the posterolateral structures produced small increases in external rotation. Large increases in external rotation were found only if the lateral collateral ligament was also sectioned. The posterolateral structures act in concert with the lateral collateral ligament in restraining internal and external rotation. External rotation was affected at all flexion angles; internal rotation was affected mainly in extension. Our results can be used in the diagnosis of complex knee ligament injuries. Findings of increased anterior translation in both flexion and extension and increased internal rotation at 90 degrees of flexion are consistent with combined injury to the anterior cruciate ligament and the anterolateral structures. The anterior cruciate ligament-deficient knee with significant posterolateral compromise (posterolateral structures/lateral collateral ligament) would exhibit larger anterior translation in extension than in flexion, increased adduction, and increased external rotation in both flexion and extension. PMID:8465922

  3. Early Clinical Results of Arthroscopic Remplissage in Patients with Anterior Shoulder Instability with Engaging Hill-Sachs Lesion in Iran

    PubMed Central

    Aslani, Hamidreza; Zafarani, Zohreh; Ebrahimpour, Adel; Salehi, Shahin; Moradi, Ali; Sabzevari, Soheil

    2014-01-01

    Background: To assess the outcome of the remplissage arthroscopic surgical method in patients with anterior shoulder dislocation associated with Hill-Sachs lesion. Methods: Ten patients with anterior shoulder dislocations and Hill-Sachs lesions were entered into this study and were operated on by the remplissage arthroscopic surgical method. They were followed up 22 months after surgery in order to evaluate the outcome of the treatment, including recurrence of dislocation and motion limitation. Results: During the internal follow up period, no case of recurrence was found. Motion limitation during the follow up period was not significant (internal rotation limitation=5°±1°, and external rotation limitation=4°±1°) Conclusions: Our findings suggest that the remplissage arthroscopic surgical method is an acceptable, safe and reliable treatment for anterior shoulder dislocation with engaging Hill-Sachs lesion. PMID:25207312

  4. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction

    PubMed Central

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Results: Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P < 0.05). Mean operation time was 235.27 ± 58.88 min in the improved tibial inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P < 0.05). Posterior drawer test were negative in 15 cases, slight positive in 2 with improved tibial inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Conclusion: Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good. PMID:25419349

  5. Fracture of the proximal extremity of the tibia after anterior cruciate ligament reconstruction: case report?

    PubMed Central

    de Oliveira Carneiro, Márcio; de Almeida Monteiro, Thiago; Zenovello Bueno, Marcos Renato; Augustin Júnior, Jorge Luis

    2015-01-01

    We report a rare condition that has been little described in the literature: a fracture of the proximal extremity of the tibia after anterior cruciate ligament reconstruction using an autologous patellar bone-tendon graft. In this report, we discuss the factors that predisposed toward this episode, the treatment and the evolution of the case after the surgical treatment. PMID:26229944

  6. Early histologic, metabolic, and vascular assessment of anterior cruciate ligament autografts

    SciTech Connect

    Kleiner, J.B.; Amiel, D.; Harwood, F.L.; Akeson, W.H.

    1989-01-01

    A rabbit model for anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon was utilized to study the early events of autograft cellular dynamics. Biochemical, autoradiographic, histological, and vascular injection techniques demonstrated that the native autograft cell population rapidly necroses. This repopulation occurs without a vascular contribution; cells entering the autograft are reliant upon synovial fluid nutrition.

  7. Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.

    ERIC Educational Resources Information Center

    Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

    2001-01-01

    Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

  8. Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.

    ERIC Educational Resources Information Center

    Pettitt, Robert W.; Bryson, Erin R.

    2002-01-01

    Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

  9. Anterior Cruciate Ligament Reconstruction and Preservation: The Single–Anteromedial Bundle Biological Augmentation (SAMBBA) Technique

    PubMed Central

    Sonnery-Cottet, Bertrand; Freychet, Benjamin; Murphy, Colin G.; Pupim, Barbara H.B.; Thaunat, Mathieu

    2014-01-01

    Preservation of the anterior cruciate ligament (ACL) remnant during ACL reconstruction has the advantages of improved vascularity and synovial encircling of the graft tendon. We describe a technique called single–anteromedial bundle biological augmentation (SAMBBA) using complete preservation of the ACL remnant, as well as preservation of the semitendinosus tibial insertion, that uses standard portals and equipment. PMID:25685675

  10. Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study

    PubMed Central

    Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

    2014-01-01

    [Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury. PMID:25364100

  11. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years' minimum follow-up.

    PubMed

    Nín, J R; Leyes, M; Schweitzer, D

    1996-01-01

    A prospective study was performed on 101 patients who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with fresh-frozen patellar tendon allograft (bone-patellar tendon-bone). We present the results of the first 60 patients with a minimum follow-up of 2 years. Thirty-four were men and 26 women with a mean age of 23. In 45 patients, a postoperative arthroscopy was performed, and tissue biopsies of the reconstructed ACL were obtained. Patients were evaluated according to the International Knee Documentation Committee evaluation form. After a mean follow-up of 47 months, the overall results were normal or nearly normal in 85%. Under postoperative arthroscopy, the macroscopic appearance of the implant was similar to that of a normal ligament. The ACL allograft was covered with a normal, well-vascularized synovium. There were no cases of infection, disease transmission or tissue rejection. We conclude that the use of fresh-frozen patellar tendon allografts is a good method of ACL reconstruction. PMID:8961227

  12. Arthroscopic anterior shoulder stabilization with percutaneous assistance and posteroinferior capsular plication.

    PubMed

    Levy, David M; Gvozdyev, Borys V; Schulz, Brian M; Boselli, Karen J; Ahmad, Christopher S

    2014-08-01

    To study the technique and clinical outcomes of arthroscopic shoulder stabilization with anterior labral repair and percutaneous posteroinferior capsular plication, we retrospectively reviewed 20 cases. Mean (SD) final postoperative follow-up was 3.4 (0.6) years (range, 2.7-5.1 years). A mean (SD) of 4.9 (0.9) suture anchors (range, 4-7) was used during surgery, with 1.6 (0.7) (range, 1-3) devoted to the posteroinferior plication. There were statistically significant improvements in forward elevation (P = .016) and internal rotation (P = .018) from before surgery to final postoperative follow-up; external rotation did not change (P = .336). Significant improvements (P < .001) were also seen in visual analog scale pain ratings, American Shoulder and Elbow Surgeons survey scores, and Simple Shoulder Test scores. Mean (SD) Rowe instability score at final follow-up was 81.1 (28.9). Eighty-five percent of the patients returned to sport at or above preinjury level, and 70% returned to a degree of athletic physical contact at or above preinjury level. Two cases (10%) were categorized as treatment failures (redislocation). Percutaneously assisted arthroscopic anterior stabilization with posteroinferior capsular plication produces acceptable results, with functional outcomes and redislocation rates comparable to those reported in the literature. PMID:25136869

  13. The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kang, Hong Je; Kim, Kwang Mee; Cho, Hang Hwan; Espinosa, Johnsel C.

    2015-01-01

    Background Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. Methods Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. Results The clinical success rate was 95.4% and the HSS scores were 93.9 ± 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. Conclusions The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction. PMID:26217463

  14. Potential commercial application of a bi-layer bone-ligament regeneration scaffold to anterior cruciate ligament replacement

    E-print Network

    Li, Jessica C. (Jessica Ching-Yi)

    2006-01-01

    A business model was created in order to explore the commercial application of a bi-layer bone-ligament scaffold to the treatment of torn anterior cruciate ligaments (ACL) requiring replacement. The two main keys in producing ...

  15. One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation

    PubMed Central

    D’Ambrosi, Riccardo; Perfetti, Carlo; Garavaglia, Guido; Taverna, Ettore

    2015-01-01

    This case presents the challenges of the surgical management for a patient with a history of recurrent posterior shoulder instability and subsequently traumatic anterior dislocation. The patient was already on the waiting list for an arthroscopic posterior stabilization with anchors, when a car accident caused an additional anterior shoulder dislocation. This traumatic anterior dislocation created a bone loss with a glenoid fracture and aggravated the preexisting posterior instability. In order to address both problems, we decided to perform an arthroscopically assisted Latarjet procedure for anterior instability and to stabilize with a bone graft for posterior instability. To our best knowledge, this type of surgical procedure has so far never been reported in the literature. The purpose of this report is to present the surgical technique and to outline the decision making process. PMID:26288539

  16. Inner Synovial Membrane Footprint of the Anterior Elbow Capsule: An Arthroscopic Boundary

    PubMed Central

    Kamineni, Srinath; Bachoura, Abdo; Sasaki, Koichi; Reilly, Danielle; Harris, Kate N.; Sinai, Anthony; Deane, Andrew

    2015-01-01

    Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release. PMID:26380112

  17. Effects of androgens on cultured cells derived from canine anterior cruciate ligament.

    PubMed

    Ohno, Hideki; Kowatari, Yoko; Owaki, Masao; Ohta, Joji; Nakajima, Naoshi; Yoshioka, Kazuki; Mutoh, Ken-ichiro; Oyamada, Toshifumi

    2012-01-01

    Anterior cruciate ligament (ACL) fibroblasts obtained from beagle dogs were cultured in basal medium containing different concentrations of 1 to 10(-3) µM 5?-dihydrotestosterone (DHT) and in basal medium itself as a control. It was demonstrated that DHT promoted cell proliferation activity, expression of androgen receptor, and collagen synthesis in ACL fibroblasts as compared with control. These results suggest that sex hormones are involved in the sex difference seen in ACL rupture of dogs. PMID:23117302

  18. Anterior cruciate ligament injuries in children with open physes: evolving strategies of treatment.

    PubMed

    Bales, Chris P; Guettler, Joseph H; Moorman, Claude T

    2004-12-01

    Injury to the anterior cruciate ligament is one of the most common sports-related injuries of the knee. Before the 1980s, the incidence of this injury in skeletally immature patients was thought to be rare. However, with the increasing participation of children in sports-related activities and an increased awareness and diagnostic capability of the medical community, midsubstance tears of the anterior cruciate ligament have become more common in patients with open physes. Significant controversy exists regarding management of anterior cruciate ligament injuries in children with open physes. Traditional management has been nonoperative, consisting of physical therapy, bracing, and activity modification. Surgical reconstruction has generally been postponed until the patient is nearing, or has reached, skeletal maturity. In contrast to this traditional treatment algorithm, the recent literature uniformly indicates that nonoperative management of anterior cruciate ligament tears in children results in less than optimal results. Compliance is certainly an issue, and even though patients may refrain from organized sports activities, they are still going to be "kids." Recurrent instability, pain, and an inability to return to the preinjury level of athletics often result. Even more worrisome are the risks of secondary meniscal tears and the possibility of early degenerative joint disease. Recently, there has been an increased interest in early, aggressive operative management to restore stability to the immature knee. Proponents of nonoperative treatment point to the risk of growth arrest associated with violation of the physis. Proponents of early operative stabilization advocate that restoration of stability provides for opportunity to return to full activity and provides good long-term outcomes, all with minimal risk to the physis. This article reviews both the basic science and clinical research on this controversial topic. PMID:15572331

  19. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction.

    PubMed

    Baer, Geoffrey S; Harner, Christopher D

    2007-10-01

    Anterior cruciate ligament (ACL) injuries are the most common complete ligamentous injury to the knee. The optimal graft should be able to reproduce the anatomy and biomechanics of the ACL, be incorporated rapidly with strong initial fixation, and cause low graft-site morbidity. This article reviews the literature comparing the clinical outcomes following allograft and autograft ACL reconstruction and examines current issues regarding graft choice. PMID:17920959

  20. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.

    PubMed

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections. PMID:11770503

  1. Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament.

    PubMed

    Fleming, B; Beynnon, B D; Johnson, R J; McLeod, W D; Pope, M H

    1993-01-01

    This study was designed to compare the displacement patterns of an isometer, used to determine graft placement during reconstruction, with the actual tensions on an anterior cruciate ligament substitute. In cadaveric specimens, a Kevlar anterior cruciate ligament substitute was implanted in three separate femoral sites, each of which was subsequently fixed to two different tibial sites. The initial tension of the Kevlar substitute was set to 22 or 33 N at 20 degrees of knee flexion. The displacement patterns for each position were recorded during passive flexion-extension using the isometer. Using a custom-designed tensiometer, the tensile forces on the substitute after rigid fixation at the tibia and femur were measured. During passive flexion-extension, the maximum change in tension of the anterior cruciate ligament substitute, measured by the tensiometer, was correlated with the maximum change in displacement between attachment sites, measured by the isometer. The coefficient of determination was equal to 0.15, indicating that the isometer may not accurately predict the tensions developed in the substitute. PMID:8427374

  2. Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion–Based Rehabilitation Progression

    PubMed Central

    ADAMS, DOUGLAS; LOGERSTEDT, DAVID; HUNTER-GIORDANO, AIRELLE; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

    2013-01-01

    SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology. PMID:22402434

  3. In-vitro correlation between tension and length change in an anterior cruciate ligament substitute.

    PubMed

    Good, L

    1995-06-01

    The length change and tension patterns from multiple insertion locations of an anterior cruciate ligament substitute were studied in 10 cadaver knees. Length change was measured with a spring-loaded isometer of low stiffness, and tension was measured with a piezoelectric load cell. In both instances a thin Kevlar test ligament was positioned in five different femoral and two different tibial ligament insertion locations, that were all located within the normal attachments of the anterior cruciate ligament. Differences were found regarding length changes and tension patterns from a simulated active extension between the central, posterior, and anterior femoral locations. All locations showed larger length change and tension values in extension than in flexion. The anterior femoral ligament insertion location showed length change and tension patterns with increasing values in flexion compared to the other femoral locations. The anterior tibial ligament insertion location showed smaller excursions of both length and tension, than did the central one, but the patterns of the curves were similar. A statistically significant correlation was found between length change and tension patterns throughout a 130-0 degrees range of motion. A statistically significant correlation was also found between the maximum length and tension values. No fixed relationship was found between the magnitude of the length and tension values, when different intervals of the range of motion were studied. RELEVANCE: The intraoperative employment of length change measurements of a test ligament in anterior cruciate ligament reconstruction gives information on where high tension can be expected in the range of motion of the knee, and how this can differ depending on the angle of graft fixation. The information gained can also be used to improve drill channel location. However, no predictions on the magnitude of tension can be made, mainly due to large biological variability. PMID:11415553

  4. Effect of Varying Hamstring Tension on Anterior Cruciate Ligament Strain During in Vitro Impulsive Knee Flexion and Compression Loading

    PubMed Central

    Withrow, Thomas J.; Huston, Laura J.; Wojtys, Edward M.; Ashton-Miller, James A.

    2008-01-01

    Background: The hamstring muscles are well positioned to limit both anterior tibial translation and anterior cruciate ligament strain during the knee flexion phase of a jump landing. We hypothesized that systematically increasing or decreasing hamstring tension during the knee flexion phase of a simulated jump landing would significantly affect peak relative strain in the anterior cruciate ligament. Methods: Ten cadaveric knees from four male and six female donors (mean age [and standard deviation] at the time of death, 60.3 ± 23.6 years) were mounted in a custom fixture to initially position the specimen in 25° of knee flexion and simulate axial impulsive loading averaging 1700 N to cause an increase in knee flexion. Quadriceps, hamstring, and gastrocnemius muscle forces were simulated with use of pretensioned linear springs, with the tension in the hamstrings arranged to be increased, held constant, decreased, at “baseline,” or absent during knee flexion. Impulsive loading applied along the tibia and femur was monitored with use of triaxial load transducers, while uniaxial load cells monitored quadriceps and medial and lateral hamstring forces. Relative strain in the anterior cruciate ligament was measured with use of a differential variable reluctance transducer, and tibiofemoral kinematics were measured optoelectronically. For each specimen, anterior cruciate ligament strains were recorded over eighty impact trials: ten preconditioning trials, ten “baseline” trials involving decreasing hamstring tension performed before and after three sets of ten trials conducted with increasing hamstring tension, constant hamstring tension, or no hamstring tension. Peak relative strains in the anterior cruciate ligament were normalized for comparison across specimens. Results: Increasing hamstring force during the knee flexion landing phase decreased the peak relative strain in the anterior cruciate ligament by >70% compared with the baseline condition (p = 0.005). Neither a constant hamstring muscle force nor the absence of a hamstring force significantly changed the peak strain in the anterior cruciate ligament relative to the baseline condition. Conclusions: Increasing hamstring muscle force during the knee flexion phase of a simulated jump landing significantly reduces the peak relative strain in the anterior cruciate ligament in vitro. Clinical Relevance: It may be possible to proactively limit peak anterior cruciate ligament strain during the knee flexion phase of jump landings by accentuating hip flexion, thereby increasing the tension in active hamstring muscles by lengthening them. PMID:18381320

  5. Can platelet-rich plasma enhance anterior cruciate ligament and meniscal repair?

    PubMed

    Hutchinson, Ian D; Rodeo, Scott A; Perrone, Gabriel S; Murray, Martha M

    2015-02-01

    The use of platelet-rich plasma (PRP) to improve clinical outcome following a soft tissue injury, regeneration, and repair has been the subject of intense investigation and discussion. This article endeavors to relate clinical and basic science strategies focused on biological augmentation of the healing response in anterior cruciate ligament (ACL) and meniscus repair and replacement using PRP. Therein, a translational feedback loop is created in the literature and targeted towards the entire multidisciplinary team. Ultimately, it is hoped that the theoretical benefits of PRP on soft-tissue interfacial healing will emerge clinically following a careful, focused characterization at the benchtop, and prospective randomized controlled clinical study. PMID:25101873

  6. Tibial plateau fracture after primary anatomic double-bundle anterior cruciate ligament reconstruction: a case report.

    PubMed

    Gobbi, Alberto; Mahajan, Vivek; Karnatzikos, Georgios

    2011-05-01

    Tibial plateau fracture after primary anatomic double-bundle anterior cruciate ligament (ACL) reconstruction is rare. To our knowledge, this is the first case report of a tibial plateau fracture after primary anatomic double-bundle ACL reconstruction. In our patient the tibial plateau fracture occurred after a torsional injury to the involved extremity. The fracture occurred 4.5 years after the ACL reconstruction. The fracture was intra-articular Schatzker type IV and had a significant displacement. The patient was treated operatively by open reduction-internal fixation. He recovered well. PMID:21663727

  7. Anterior Cruciate Ligament Injury Prevention and Rehabilitation: Let's Get It Right.

    PubMed

    Wilk, Kevin E

    2015-10-01

    Anterior cruciate ligament (ACL) injuries are among the most common and functionally disabling conditions in orthopaedics and sports medicine. As professionals, we need to do a better job of screening individuals to determine who is at greatest risk of sustaining an ACL injury, as well as implementing injury prevention programs. We also need to do a better job with programs that return individuals to their preinjury activity levels, including implementing thorough functional testing to determine if a patient is ready to return to sports or strenuous activities post-ACLR. J Orthop Sports Phys Ther 2015;45(10):729-730. doi:10.2519/jospt.2015.0109. PMID:26424574

  8. Editorial: Functional testing in the assessment of return to sports after anterior cruciate ligament reconstruction

    PubMed Central

    Sun, Luning; Fan, Jing; Gill, Thomas J.

    2015-01-01

    The paper entitled “Functional testing differences in anterior cruciate ligament (ACL) reconstruction patients released versus not released to return to sport” published in the American Journal of Sports Medicine (AJSM) assessed Functional Movement Screen (FMS) and the Lower Quarter Y Balance Test (YBT-LQ) as possible objective tools for evaluating a patient’s readiness to return to sports after ACL reconstruction. The results suggest that many patients clinically cleared continue to have measurable function deficits and that both FMS and YBT-LQ may be used as additional tools for return to sports clearance. PMID:26539442

  9. Arthroscopic lavage speeds reduction in effusion in the glenohumeral joint after primary anterior shoulder dislocation: a controlled randomized ultrasound study.

    PubMed

    Wintzell, G; Hovelius, L; Wikblad, L; Saebö, M; Larsson, S

    2000-01-01

    Recent studies have shown that arthroscopic lavage of the glenohumeral joint within 10 days following a primary anterior dislocation significantly lowers the recurrence rate when compared with a nonoperative regime. We hypothesize that the lavage reduces distension in the joint and thereby facilitates adaptation and healing of the soft tissue lesion. Using ultrasound, we assessed the hemarthrosis in the glenohumeral joint weekly in 16 consecutive patients after traumatic primary anterior shoulder dislocation. The patients were randomized into two groups for treatment with either arthroscopic lavage or a nonoperative regime. Except for the lavage the two groups followed an identical rehabilitation program. Transversal dorsal ultrasound of the glenohumeral joint was performed, in which the joint effusion was assessed as the distance between the humeral head and the glenoid. Prior to the lavage the two groups had a similar amount of excessive joint effusion. The effusion declined to a steady state level within 3-7 weeks. The joint effusion decreased more rapidly (33%) in the group treated with arthroscopic lavage (P = 0.02) than in the nonoperated group. PMID:10663322

  10. An electromyographic analysis of the knee during functional activities. II. The anterior cruciate ligament-deficient and -reconstructed profiles.

    PubMed

    Ciccotti, M G; Kerlan, R K; Perry, J; Pink, M

    1994-01-01

    This study compared the electromyographic activity of normal (N = 22), rehabilitated anterior cruciate ligament-deficient (N = 8), and -reconstructed knees (N = 10) while subjects performed activities. Each subject had evaluation of 8 muscles during 7 functional activities. Sixty-seven percent of the differences in the quadriceps muscle reflected increased activity in the vastus lateralis muscle of the rehabilitated group; 75% of the differences in the hamstrings muscles noted increased biceps femoris muscle activity in the rehabilitated group; 56% of the differences in the lower leg musculature showed increased tibialis anterior muscle activity in the rehabilitated group. Eighty-six percent of the statistically different intervals involved rehabilitated subjects demonstrating increased activity over reconstructed or normal subjects or both. The presence of a quadriceps-hamstrings muscles coordinated response was identified consistently in all 3 groups in each activity. This study supports surgical reconstruction for the anterior cruciate ligament-deficient knee. It also demonstrates the importance of the vastus lateralis, biceps femoris, and tibialis anterior musculature in the rehabilitation of the anterior cruciate ligament-deficient patient. The presence of a quadriceps-hamstrings muscles coordinated response indicates that mechanoreceptors mediating this reflex arc exist in structures other than the cruciate ligament. PMID:7810789

  11. The role of the RNFA in anterior cruciate ligament graft preparation.

    PubMed

    Rozakis, Melissa

    2014-11-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopedic procedures in the United States. Repair of the ACL often requires the use of autografts or allografts, and the RN first assistant (RNFA) often is the team member responsible for preparing the graft. Common grafts used in ACL repair include bone-patellar tendon-bone, hamstring, Achilles tendon, quadriceps tendon, and tibialis anterior tendon. The RNFA must be competent in preparing all of these grafts and in understanding the advantages and disadvantages of using each graft, such as the reasons for graft choice, and must ensure that all graft-related supplies and equipment are available and ready for use. The ability to prepare all graft types expands treatment options, reduces surgical time, and enhances the role of the RNFA. PMID:25443120

  12. Arthroscopic Repair of Inferior Labrum From Anterior to Posterior Lesions Associated With Multidirectional Instability of the Shoulder

    PubMed Central

    Burt, David M.

    2014-01-01

    Multidirectional instability (MDI) of the shoulder may arise spontaneously; however, recent evidence suggests that traumatic events may play a role in this syndrome. Variable degrees of injury around the circumference of the glenoid have been reported, ranging from Bankart and Kim lesions to 270° of injury and even 360° of injury. Hyperabduction injury may cause inferior subluxation of the shoulder and result in traumatic isolated injury to the inferior labrum from anterior to posterior. This particular lesion spans approximately 180° of the inferior hemisphere and may lead to symptomatic MDI. In contrast to open or arthroscopic plication procedures for atraumatic MDI without labral injury, the goal in these cases is anatomic arthroscopic repair of the inferior labrum tear without the need for capsular plication, volume reduction, or rotator interval closure. PMID:25685683

  13. Tibial bone plug resorption with extra-articular cyst: a rare complication of anterior cruciate ligament reconstruction.

    PubMed

    Brettler, D; Soudry, M

    1995-08-01

    Anterior cruciate ligament (ACL) reconstruction failure resulted in tibial bone plug resorption and the formation of a large extra-articular cyst. To our knowledge, this is the first report of this kind of ACL failure. The relationship to known factors is discussed. PMID:7575883

  14. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial-side injuries of the knee.

    PubMed

    Hubert, Mark G; Stannard, James P

    2011-06-01

    KD-IIIM knee injuries are challenging injuries that can do well when anatomic reconstruction techniques are used. This article describes the authors preferred reconstructions, timing of surgery, and rehabilitation techniques. The reconstructions are generally initiated 3 or 4 weeks after the injury when the local soft tissue injury allows and associated fractures have already been stabilized. The posterior cruciate ligament, posteromedial corner, and meniscus injuries are addressed in the initial operation. The corresponding author prefers to come back 6 weeks later and reconstruct the anterior cruciate ligament and assure that acceptable progress has been made regarding knee motion. PMID:21540707

  15. Arthroscopically Confirmed Femoral Button Deployment

    PubMed Central

    Sonnery-Cottet, Bertrand; Rezende, Fernando C.; Martins Neto, Ayrton; Fayard, Jean M.; Thaunat, Mathieu; Kader, Deiary F.

    2014-01-01

    The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means “one size fits all,” thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications. PMID:25126492

  16. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    PubMed

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V. PMID:26387120

  17. Lessons Learnt from an Atypical Mycobacterium Infection Post-Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yee Han, Dave Lee

    2015-01-01

    Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well. PMID:25729530

  18. Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Bonasia, Davide Edoardo; D’Amelio, Andrea; Pellegrino, Pietro; Rosso, Federica; Rossi, Roberto

    2015-01-01

    Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes. PMID:26330991

  19. Regeneration of the anterior cruciate ligament: Current strategies in tissue engineering

    PubMed Central

    Nau, Thomas; Teuschl, Andreas

    2015-01-01

    Recent advancements in the field of musculoskeletal tissue engineering have raised an increasing interest in the regeneration of the anterior cruciate ligament (ACL). It is the aim of this article to review the current research efforts and highlight promising tissue engineering strategies. The four main components of tissue engineering also apply in several ACL regeneration research efforts. Scaffolds from biological materials, biodegradable polymers and composite materials are used. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in a few animal studies and the results are encouraging. The different strategies, from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and regeneration, are under constant development. We expect considerable progress in the near future that will result in a realistic option for ACL surgery soon. PMID:25621217

  20. State-of-the-art anterior cruciate ligament tears: A primer for primary care physicians.

    PubMed

    Salzler, Matt; Nwachukwu, Benedict U; Rosas, Samuel; Nguyen, Chau; Law, Tsun Yee; Eberle, Thomas; McCormick, Frank

    2015-05-01

    The purpose of this article is to provide primary care physicians and other members of the medical community with an updated, general review on the subject of anterior cruciate ligament (ACL) tears. We aim to enhance awareness of these injuries and to prepare those practicing in the primary care setting to address these injuries. Because ACL injuries are quite common, it is very likely that a primary care physician will encounter these injuries and need to address them acutely. The current literature is replete with new concepts and controversies regarding ACL injuries, and this article provides a concise review for our target audience in regard to the care of a patient with an ACL injury. This article is composed of an overview with current epidemiologic data, basic anatomy and physiology, clinical presentation, physical examination findings, imaging modalities, and treatment options. After reading this short article, a medical care provider should understand ACL injuries and their appropriate management. PMID:25703144

  1. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw

    PubMed Central

    Joshi, Yogesh V.; Phaltankar, Padmanabh M.; Charalambous, Charalambos P.

    2015-01-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  2. Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature.

    PubMed

    Bauer, Matthew; Feeley, Brian T; Wawrzyniak, John R; Pinkowsky, Gregory; Gallo, Robert A

    2014-11-01

    Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities. PMID:25419890

  3. X-ray computed tomography of the anterior cruciate ligament and patellar tendon

    PubMed Central

    Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

    2014-01-01

    Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL. PMID:25332942

  4. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    PubMed Central

    Simon, David; Saltzman, Bryan M.; Rollins, Meaghan; Bach, Bernard R.; MacDonald, Peter

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

  5. Biomechanical Characterization of a Model of Noninvasive, Traumatic Anterior Cruciate Ligament Injury in the Rat.

    PubMed

    Maerz, Tristan; Kurdziel, Michael D; Davidson, Abigail A; Baker, Kevin C; Anderson, Kyle; Matthew, Howard W T

    2015-10-01

    The onset of post-traumatic osteoarthritis (PTOA) remains prevalent following traumatic joint injury such as anterior cruciate ligament (ACL) rupture, and animal models are important for studying the pathomechanisms of PTOA. Noninvasive ACL injury using the tibial compression model in the rat has not been characterized, and it may represent a more clinically relevant model than the common surgical ACL transection model. This study employed four loading profiles to induce ACL injury, in which motion capture analysis was performed, followed by quantitative joint laxity testing. High-speed, high-displacement loading repeatedly induces complete ACL injury, which causes significant increases in anterior-posterior and varus laxity. No loading protocol induced valgus laxity. Tibial internal rotation and anterior subluxation occurs up to the point of ACL failure, after which the tibia rotates externally as it subluxes over the femoral condyles. High displacement was more determinative of ACL injury compared to high speed. Low-speed protocols induced ACL avulsion from the femoral footprint whereas high-speed protocols caused either midsubstance rupture, avulsion, or a combination injury of avulsion and midsubstance rupture. This repeatable, noninvasive ACL injury protocol can be utilized in studies assessing PTOA or ACL reconstruction in the rat. PMID:25777293

  6. Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells

    SciTech Connect

    Miyake, Yoshiaki; Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama ; Furumatsu, Takayuki; Kubota, Satoshi; Kawata, Kazumi; Ozaki, Toshifumi; Takigawa, Masaharu

    2011-06-03

    Highlights: {yields} CCN2/CTGF localizes to the ligament-to-bone interface, but is not to the midsubstance region of human anterior cruciate ligament (ACL). {yields} Mechanical stretch induces higher increase of CCN2/CTGF gene expression and protein secretion in ACL interface cells compared with ACL midsubstance cells. {yields} CCN2/CTGF treatment stimulates the proliferation of ACL interface cells. -- Abstract: Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates {alpha}1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.

  7. Arthroscopy-assisted anterior cruciate ligament reconstruction with patellar tendon or hamstring autografts.

    PubMed

    Doral, M N; Leblebicioglu, G; Atay, O A; Baydar, M L; Tetik, O; Atik, S

    2000-01-01

    Isolated ACL reconstructions were performed in 138 patients between 1994 and 1998. Patellar bone-patellar tendon-bone, and hamstring tendon autografts were used in 88 patients, and allografts were used in 50 patients. Eighty-eight knees of 88 patients with autograft reconstructions (17 female, 71 male) were included in this study and evaluation of the patients with allograft reconstruction reported separately. The mean age at the time of the operation was 32 years. All ACL reconstructions were performed arthroscopically. Twenty-seven bone-patellar tendon-bone, and 61 hamstring tendon autografts were used. The mean follow-up was 29 months. In the postoperative course the Lachman test was negative in 62 patients, 1+ in 22 patients, and 2+ in 4 patients. In 17 patients, anterior drawer sign were 1+ in comparison to the contralateral side. Pivot shift test was moderately positive only in 5 cases in the bone-patellar tendon-bone and hamstring tendon autograft groups postoperatively. There were 3 patients with subjective "giving way" symptoms. Second look arthroscopy revealed rupture of the neo-ligament. Arthroscopic washout and debridement were performed, and no revision ligamentoplasties were performed. Two of these patients improved with accelerated proprioceptive physical therapy, and one had to decrease his previous level of activity. There were no cases of arthrofibrosis, infection, or extension lag. Clinical results of patellar bone-tendon-bone and hamstring groups did not show any significant clinical difference. Avoiding the disturbance of the extensor mechanism of the knee is probably the most significant advantage of the hamstring autograft. PMID:10983256

  8. Biomechanical Outcomes After Bio-enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction Are Equal in a Porcine Model

    PubMed Central

    Vavken, Patrick; Fleming, Braden C.; Mastrangelo, Ashley N.; Machan, Jason T.; Murray, Martha M.

    2011-01-01

    Purpose The objective of this study was to compare the biomechanical outcomes of a new method of anterior cruciate ligament (ACL) treatment, bio-enhanced ACL repair, with ACL reconstruction in a large animal model. Methods Twenty-four skeletally immature pigs underwent unilateral ACL transection and were randomly allocated to receive bio-enhanced ACL repair with a collagen-platelet composite, allograft (bone–patellar tendon– bone) reconstruction, or no further treatment (n = 8 for each group). The structural properties and anteroposterior laxity of the experimental and contralateral ACL-intact knees were measured 15 weeks postoperatively. All dependent variables were normalized to those of the contralateral knee and compared by use of generalized linear mixed models. Results After 15 weeks, bio-enhanced ACL repair and ACL reconstruction produced superior biomechanical outcomes to ACL transection. However, there were no significant differences between bio-enhanced ACL repair and ACL reconstruction for maximum load (P = .4745), maximum displacement (P = .4217), or linear stiffness (P = .6327). There were no significant differences between the 2 surgical techniques in anteroposterior laxity at 30° (P = .7947), 60° (P = .6270), or 90° (P = .9008). Conclusions Bio-enhanced ACL repair produced biomechanical results that were not different from ACL reconstruction in a skeletally immature, large animal model, although the variability associated with both procedures was large. Both procedures produced significantly improved results over ACL transection, showing that both were effective in this model. Clinical Relevance Bio-enhanced ACL repair may 1 day provide an alternative treatment option for ACL injury. PMID:22261137

  9. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis.

    PubMed

    Bates, Nathaniel A; Myer, Gregory D; Shearn, Jason T; Hewett, Timothy E

    2015-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

  10. Anterior Cruciate Ligament Biomechanics During Robotic and Mechanical Simulations of Physiologic and Clinical Motion Tasks: A Systematic Review and Meta-Analysis

    PubMed Central

    Bates, Nathaniel A.; Myer, Gregory D.; Shearn, Jason T.; Hewett, Timothy E.

    2014-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

  11. Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms

    PubMed Central

    Levine, Jason W.; Kiapour, Ata M.; Quatman, Carmen E.; Wordeman, Samuel C.; Goel, Vijay K.; Hewett, Timothy E.; Demetropoulos, Constantine K.

    2014-01-01

    Background The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures. Purpose The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries. Study Design Controlled laboratory study. Methods Seventeen cadaveric legs (age, 45 ± 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25° of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the ?2 test for independence. Results Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were significantly (P = .002) dependent on the applied loading conditions. Damage to the articular cartilage along with depression of the midlateral tibial plateau was primarily associated with knee abduction moments, while cartilage damage with depression of the posterolateral tibial plateau was primarily associated with internal tibial rotation moments. Conclusion The current findings demonstrate the relationship between the location of the tibial plateau injury and ACL injury mechanisms. The resultant injury locations were similar to the clinically observed bone bruises across the tibial plateau during a noncontact ACL injury. These findings indicate that abduction combined with other modes of loading (multiplanar loading) may act to produce ACL injuries. Clinical Relevance A better understanding of ACL injury mechanisms and associated risk factors may improve current preventive, surgical, and rehabilitation strategies and limit the risk of ACL and secondary injuries, which may in turn minimize the future development of posttraumatic osteoarthritis of the knee. PMID:23144366

  12. Nutrition of the anterior cruciate ligament. Effects of continuous passive motion

    SciTech Connect

    Skyhar, M.J.; Danzig, L.A.; Hargens, A.R.; Akeson, W.H.

    1985-11-01

    Twelve freshly killed mature male rabbits were used to study the effects of continuous passive motion (CPM) on regional and overall nonvascular nutritional pathways of the anterior cruciate ligament (ACL). One hundred fifty microcuries of /sup 35/S-sulfate was injected intraarticularly into each knee joint. The right knee underwent CPM for 1 hour, while the left knee remained immobilized. Both knee joints were then isolated and immediately frozen. The ACLs were removed while still mostly frozen, and sectioned into anterior, middle, and posterior thirds for the six rabbits in Group 1, and proximal, middle, and distal thirds for the six rabbits in Group 2. In addition, quadriceps tendon samples were harvested from each limb of three rabbits. After appropriate processing, all samples were counted in a scintillation counter, and counts per minute per milligram of tissue were calculated. There was significantly higher uptake in rest extremity ACLs compared to CPM extremity ACLs (P = 0.0001). No significant difference was demonstrated in regional uptake comparing respective thirds of the ACL in either Group 1 or Group 2. Quadriceps tendon uptake trended higher in the limbs exposed to CPM compared to those maintained at rest (P = 0.14). The ACL uses diffusion as a primary nutrient pathway. CPM does not increase nutrient uptake by the ACL in this avascular model, but CPM may facilitate transport of metabolites out of the joint. No regional differences in uptake within the ACL occurred in either group.

  13. [Plastic surgery of the anterior cruciate ligament: experimental study of intra-articular aramid fibers in dogs].

    PubMed

    Passuti, N; Daculsi, G; Gouin, F; Martin, S; Vigneron, M

    1989-01-01

    The authors explored the possibility of replacing an anterior cruciate ligament with an aramid fiber (Kevlar) implant. This study was performed in intra-articular site in 9 dogs and the average implantation period was 5 months. Studies were carried out by macroscopic, photon microscopy, and electron microscopy examination of the samples obtained at the time the animals were sacrificed. Clinical and radiographic studies of the knees were performed in order to assess functional consequences. Overall, the results showed a partial or complete rupture of 10 neoligaments out of the 17 studied ligaments; on the other hand, osseous anchorage and reintegration in the intra-articular zone appeared satisfactory. Kevlar fiber only partially meets the performance specifications for an artificial ligament intended to serve as an anterior cruciate ligament substitute. Some positive results have encouraged the authors to carry on further this experimental study. PMID:2595049

  14. Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears

    PubMed Central

    Strickland, Justin P.; Fleckenstein, Cassie M.; Ducker, Al; Hasan, Samer S.

    2010-01-01

    Background: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. Purpose: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. Study Design: Case series. Methods: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. Results: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. Conclusions: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing. PMID:23015981

  15. Arthroscopic Double-Row Anterior Stabilization and Bankart Repair for the “High-Risk” Athlete

    PubMed Central

    Moran, Cathal J.; Fabricant, Peter D.; Kang, Richard; Cordasco, Frank A.

    2014-01-01

    In addition to operative intervention for the patient with recurrent shoulder instability, current literature suggests that younger athletic patients unwilling to modify their activities may benefit from an early surgical shoulder stabilization procedure. Although open shoulder stabilization clearly has a role to play in some cases, we believe that further optimization of arthroscopic fixation techniques may allow us to continue to refine the indications for open stabilization. In particular, when an arthroscopic approach is used for capsulolabral repair in relatively high-risk groups, it may be beneficial to use a double-row repair technique. We describe our technique for shoulder stabilization through double-row capsulolabral repair of a soft-tissue Bankart lesion in the high-risk patient with shoulder instability or the patient with a small osseous Bankart lesion. PMID:24749044

  16. Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics

    PubMed Central

    Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

    2009-01-01

    Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom. PMID:19182035

  17. Measurement of functional recovery in individuals with acute anterior cruciate ligament rupture

    PubMed Central

    Button, K; van Deursen, R; Price, P; Rosenbaum, D

    2005-01-01

    Objectives: To measure functional recovery following acute anterior cruciate ligament (ACL) rupture using a simple and reliable clinical movement analysis system. Clinic based methods that simultaneously quantify different aspects of movement over a range of activities and model functional recovery will help guide rehabilitation. Methods: A longitudinal study was used to measure gait variables at initial physiotherapy attendance and then at monthly intervals using a digital camcorder and computer for quantitative analysis. Jogging and distance hopping were added during recovery. A sample of 63 ACL deficient subjects entered the study and 48 subjects were measured at least three times. To determine the pattern of recovery, repeated measurements were analysed using a least square fit of the data. Results: Gait variables took between 95 and 130 days post injury to reach the control mean and stabilise shortly after this. Hopping distance for the injured leg took 62 days to recover to within normal limits and 5 months post injury to reach the control mean. Jogging was already within the control limits at 30 days post injury and demonstrated little change with recovery. Conclusions: Functional recovery of multiple variables has been modelled. In the early phase of post injury, gait velocity seems to be the most useful variable to measure improvement. Recovery of more challenging activities appears to take an average of 5 months. Therefore, patients may need to be monitored in physiotherapy until this time and advised not to return to sport until sufficient recovery is demonstrated on activities such as distance hopping. PMID:16244200

  18. Isokinetic Identification of Knee Joint Torques before and after Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Czaplicki, Adam; Jarocka, Marta; Walawski, Jacek

    2015-01-01

    The aim of this study was to evaluate the serial change of isokinetic muscle strength of the knees before and after anterior cruciate ligament reconstruction (ACLR) in physically active males and to estimate the time of return to full physical fitness. Extension and flexion torques were measured for the injured and healthy limbs at two angular velocities approximately 1.5 months before the surgery and 3, 6, and 12 months after ACLR. Significant differences (p ? 0.05) in peak knee extension and flexion torques, hamstring/quadriceps (H/Q) strength ratios, uninvolved/involved limb peak torque ratios, and the normalized work of these muscles between the four stages of rehabilitation were identified. Significant differences between extension peak torques for the injured and healthy limbs were also detected at all stages. The obtained results showed that 12 months of rehabilitation were insufficient for the involved knee joint to recover its strength to the level of strength of the uninvolved knee joint. The results helped to evaluate the progress of the rehabilitation and to implement necessary modifications optimizing the rehabilitation training program. The results of the study may also be used as referential data for physically active males of similar age. PMID:26646385

  19. Ultrastructural and morphological characteristics of human anterior cruciate ligament and hamstring tendons.

    PubMed

    Zhu, Jingxian; Zhang, Xin; Ma, Yong; Zhou, Chunyan; Ao, Yingfang

    2012-09-01

    Hamstring tendons are a commonly used substitute for anterior cruciate ligament (ACL) reconstruction. Ligaments and tendons are similar in composition but the ACL is more complex than hamstring tendons in function and gross morphology, which are highly dependent on its structure and ultrastructure. The purpose of this study was to compare the morphology and ultrastructure of normal human ACL and hamstring tendons, including the cell type and arrangement, expression level of proteoglycans, diameter, and density of collagen fibrils. Twenty semitendinosus or gracilis tendons and 20 ACL specimens were harvested from patients with ACL rupture or osteoarthritis undergoing routine total knee arthroplasty. The specimens were examined histologically and the ultrastructure was observed using scanning and transmission electron microscopy. Semitendinosus and gracilis tendons showed a homogeneous arrangement of collagen fibers and cell type. They had lower fibril density and more widely distributed fibril diameters. In the ACL, there was a more complex arrangement of collagen fibers, distribution of proteoglycans and different cell types. Electronic microscopy demonstrated a combination of parallel, helical and nonlinear networks of ACL fibrils, and fibril diameters were smaller and more nonuniform. This study compared the anatomy of normal human ACL and hamstring tendons, which may provide a standard for evaluating hamstring tendons grafts after ACL reconstruction and may facilitate the application of hamstring tendons in clinical applications. PMID:22807249

  20. Review of evolution of tunnel position in anterior cruciate ligament reconstruction.

    PubMed

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-03-18

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  1. Saphenous nerve injury during harvesting of one or two hamstring tendons for anterior cruciate ligament reconstruction?

    PubMed Central

    de Padua, Vitor Barion Castro; Nascimento, Paulo Emílio Dourado; Silva, Sergio Candido; de Gusmão Canuto, Sergio Marinho; Zuppi, Guilherme Nunes; de Carvalho, Sebastião Marcos Ribeiro

    2015-01-01

    Objective The aim of this study was to assess whether harvesting of two hamstring tendons (semitendinosus and gracilis) has the same rate of nerve injury as harvesting of the semitendinosus tendon alone, used as a triple graft. Methods Changes in sensitivity relating to injury of the infrapatellar branch of the saphenous nerve were evaluated in 110 patients six months after they underwent anterior cruciate ligament (ACL) reconstruction using hamstring tendons. They were divided into two groups: one in which only the semitendinosus was used and the other, the semitendinosus and gracilis. Results The group in which only the semitendinosus was used as a graft presented a nerve injury rate of 36.1%. In the group in which the semitendinosus and gracilis tendons were used, 58.1% of the patients presented altered sensitivity. In the general assessment on all the patients, the nerve injury rate was 50.9%. Conclusion Harvesting the semitendinosus alone and using it in triple form is a viable option for ACL reconstruction and may give rise to fewer nerve injuries relating to branches of the saphenous nerve. PMID:26535201

  2. Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction?

    PubMed Central

    de Melo Silva Júnior, Otávio; do Nascimento Ohashi, Bruno; de Almeida, Murilo Oliveira; Reis Gonçalves, Murilo

    2015-01-01

    Objective To ascertain the coronal angles for the femoral and tibial tunnels that provide the best postoperative result from anterior cruciate ligament (ACL) reconstruction surgery, through assessing the variables of the IKDC and Lysholm–Tegner questionnaires and the hop test. Methods Sixteen patients with a single unilateral ACL injury who underwent this surgery between 24 and 36 months earlier were evaluated. They were divided into four groups in which the tibial and femoral tunnel angles were greater than or less than 65° in the coronal plane. Results The results demonstrated that a more vertical angle for the tibial tunnel (72°) and a more horizontal angle for the femoral tunnel (60°), with valgus alignment of 12° correlated with the best values for the variables studied. This may indicate that the long-term results from this surgery are excellent. Conclusion A more horizontal femoral angle and a more vertical tibial angle produced better assessments in the tests that were applied and in the functional results evaluated. PMID:26229897

  3. Immunohistochemical study on androgen receptors in the anterior cruciate ligament in dogs.

    PubMed

    Ohno, Hideki; Goto, Shunsuke; Owaki, Masao; Ohta, Joji; Nakajima, Naoshi; Nakata, Kaori; Mutoh, Ken-ichiro; Oyamada, Toshifumi; Yoshioka, Kazuki

    2013-01-01

    Androgen is closely involved as the cause of rupture of anterior cruciate ligament (ACL) in human. In dogs, however, factors contributing to rupture of ACL remain unknown. In this study, expression of androgen receptor (AR) and histological distribution of blood vessels in ACL, and serum testosterone concentration were investigated in relation with age and sex to confirm whether canine ACL is an androgen-responsive tissue. Materials of ACL were obtained from 26 dogs: 12 young female Beagles, 2 old female mixed breeds, 9 young male Beagles, and 3 old male mixed breeds. In all canine ACL, positive AR expression was recognized in the nuclei of the fibrocytes, fibroblasts, synovial cells, and vascular endothelial cells of ACL. Expressions of AR were lesser in old males compared to the young males; however, females had no age difference in expression. Distributions of blood vessels in the synovial membrane of the ligament were fewer in old dogs both of males and females than youngs. Although distributions of vessels in the interstitium were apparently fewer in young females. Serum testosterone concentration was significantly higher in young males. Females had no age difference in the levels. From these results, it is suggested that canine ACL is an androgen-responsive tissue, and this consideration seems to closely relate to the epidemiological background that the incidence of rupture of ACL of dogs is higher in females than in males. PMID:24107721

  4. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

    PubMed Central

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  5. The phenomenon of "ligamentization": anterior cruciate ligament reconstruction with autogenous patellar tendon.

    PubMed

    Amiel, D; Kleiner, J B; Roux, R D; Harwood, F L; Akeson, W H

    1986-01-01

    Reconstruction of the anterior cruciate ligament (ACL) with patellar tendon (PT) is a common procedure for the symptomatic ACL-deficient knee. Questions regarding graft incorporation, viability, and nutrition of the transplanted tissue are of concern. This relates to the graft's response to its new intrasynovial milieu and new physical forces. These factors were studied in a rabbit model of ACL reconstruction using PT and were evaluated with histological and biochemical parameters with respect to time. A histological and biochemical metamorphosis of the grafted PT occurred in this study. Autografts demonstrated a gradual assumption of the microscopic properties of normal ACL; by 30 weeks postoperatively, cell morphology was ligamentous in appearance. Normally, type III collagen is not observed in PT, however, a gradual increase in its concentration was seen in the grafts; by 30 weeks its concentration (10%) was the same as in normal ACL. Similarly, glycosaminoglycans content increased from its normally low level in PT to that found in native ACL. Collagen-reducible crosslink analysis demonstrated that grafted tissue changed from the normal PT pattern of low dihydroxylysinonorleucine (DHLNL) and high histidinohydroxymerodesmosine (HHMD) to the pattern seen in normal ACL (high DHLNL and low HHMD) by 30 weeks. These data suggest that when PT is placed in the anatomic and environmental milieu of the ACL, a "ligamentization" of the grafted tissue results; also the autograft initially depends on synovial fluid nutrition, as revascularization occurs after 6 weeks. PMID:3712125

  6. Tensile behaviour of structurally gradient braided prostheses for anterior cruciate ligaments.

    PubMed

    Rawal, Amit; Sibal, Apurv; Saraswat, Harshvardhan; Quddus Khan, Siyam

    2016-02-01

    Anterior cruciate ligament (ACL) is a key fibrous connective tissue that maintains the stability of a knee joint and it is the most commonly injured ligament of the knee. A synthetic prosthesis in the form of a braided structure can be an attractive alternative to biological grafts provided that the mechanical properties can be tailored to mimic the natural ACL. In the present work, the polypropylene based structurally gradient braided prostheses have been designed and developed by understanding their tensile properties. Circular braiding process was employed to fabricate structurally gradient braided prostheses by systematically placing different types of braids in defined set of layers. An analytical model for predicting the tensile properties of structurally gradient braided prostheses has been presented by modifying and combining the existing models available in the literature. Specifically, the full set of stress-strain behaviour of structurally gradient braided prostheses has been computed based upon braid structural characteristics, constituent strand properties and braid kinematics. A triaxial braid in the outer layer of braided prostheses was found to withstand higher tensile stresses in comparison to a biaxial braid having same structural characteristics. A comparison has been made between the theoretical and experimental results of tensile properties of structurally gradient braided prostheses. The tensile properties of structurally gradient braided prostheses predicted through analytical route matched reasonably well with the experimental results. PMID:26505530

  7. Outcome of combined autologous chondrocyte implantation and anterior cruciate ligament reconstruction

    PubMed Central

    Dhinsa, Baljinder S; Nawaz, Syed Z; Gallagher, Kieran R; Skinner, John; Briggs, Tim; Bentley, George

    2015-01-01

    Background: Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction. Materials and Methods: Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS). Results: At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures. Conclusion: The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged. PMID:26015603

  8. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    PubMed

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at ? = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years. PMID:24945476

  9. Systematic Review of Biological Modulation of Healing in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Fu, Sai-Chuen; Cheuk, Yau-Chuk; Yung, Shu-Hang; Rolf, Christer Gustav; Chan, Kai-Ming

    2014-01-01

    Background: Whether biological modulation is effective to promote healing in anterior cruciate ligament (ACL) reconstruction remains unclear. Purpose: To perform a systematic review of both clinical and experimental evidence of preclinical animal studies on biological modulation to promote healing in ACL reconstruction. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic search was performed using the PubMed, Ovid, and Scopus search engines. Inclusion criteria were clinical and animal studies involving subjects with ACL injury with the use of biological modulation to promote healing outcomes. Methodological quality of clinical studies was evaluated using the Critical Appraisal Skill Programme (CASP) appraisal tool, and animal studies were evaluated by a scoring system based on a published checklist of good animal studies. Results: Ten clinical studies and 50 animal studies were included. Twenty-five included studies were regarded as good quality, with a methodological score ?5. These studies suggested that transforming growth factor–beta (TGF-?), mesenchymal stem cells, osteogenic factors, and modalities that reduce local inflammation may be beneficial to promote graft healing in ACL reconstruction. Conclusion: This systematic review suggests that biological modulation is able to promote healing on top of surgical treatment for ACL injuries. This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation. PMID:26535311

  10. Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery.

    PubMed

    Tuman, Jeffrey; Diduch, David R; Baumfeld, Joshua A; Rubino, L Joseph; Hart, Joseph M

    2008-05-01

    Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but important clinical issue that must be resolved quickly to prevent secondary joint damage and preserve the graft. After careful analysis, we observed 3 infection cases within a 12-month period after ACL reconstruction, which represented an abnormally elevated risk. All reconstructions were performed by the same surgeon and used hamstring tendon allograft. For each surgery, the Target Tendon Harvester (DePuy Mitek, Raynham, MA) was used to harvest hamstring tendons. Through our review, we learned that this instrument was sterilized while assembled. It is our belief that ineffective sterilization of this hamstring graft harvester served as the origin for these infections. We have determined that appropriate sterilization technique involves disassembly of this particular hamstring tendon harvester before sterilization because of the tube-within-a-tube configuration. We have since continued to use the Target Tendon Harvester, disassembling it before sterilization. There have been no infections in the ensuing 12 months during which the surgeon performed over 40 primary ACL reconstructions via hamstring autograft. The information from this report is intended to provide arthroscopists with information about potential sources of infection after ACL reconstruction surgery. PMID:18442698

  11. Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor

    NASA Astrophysics Data System (ADS)

    Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

    2007-12-01

    Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

  12. Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk

    NASA Astrophysics Data System (ADS)

    Lee, Marcus J. C.; Bourke, Paul; Alderson, Jacqueline A.; Lloyd, David G.; Lay, Brendan

    2010-02-01

    Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli to impose these constraints may not be accurately identifying the relationship between the perceptual demands and ACL loading during Ssg in actual game environments. We propose that stereoscopically filmed footage featuring sport specific opposing defender/s simulating a tackle on the viewer, when used as visual stimuli, could improve the ecological validity of laboratory based investigations of evasive Ssg. Due to the need for precision and not just the experience of viewing depth in these scenarios, a rigorous filming process built on key geometric considerations and equipment development to enable a separation of 6.5 cm between two commodity cameras had to be undertaken. Within safety limits, this could be an invaluable tool in enabling more accurate investigations of the associations between evasive Ssg and ACL injury risk.

  13. Telemetry system for monitoring anterior cruciate ligament graft forces in vivo

    NASA Astrophysics Data System (ADS)

    McKee, Eric L.; Hull, Maury L.; Howell, Stephen M.

    1997-02-01

    Quantifying changes in the tension of an anterior cruciate ligament (ACL) graft in vivo during rehabilitative exercises is vital for developing the optimal rehabilitation for patients who have had reconstructive surgery. The purpose of this project was to design, built, and test a telemetry system that can measure the in vivo ACL graft tension postoperatively. A commercially available fixation device was modified to sense the graft tension, house electronic components, transmit an output signal, and pass the power generating signal. A transcutaneous inductive link was used to power the implanted telemetry electronics. The current difference technique was used to measure changes in two strain gages that monitored shear strain developed on the femoral fixation device by the ACL graft. This current regulated a frequency modulated output signal and transmitted it, by using the ionic properties of body tissue as the medium, to external EMG surface electrodes. A signal conditioning board detected and converted the output to an analog voltage for collection by a computer data acquisition system. A performance evaluation demonstrated that the telemetry system either met or exceeded al of the criteria necessary for the application.

  14. In vitro study on silk fibroin textile structure for anterior cruciate ligament regeneration.

    PubMed

    Farè, Silvia; Torricelli, Paola; Giavaresi, Gianluca; Bertoldi, Serena; Alessandrino, Antonio; Villa, Tomaso; Fini, Milena; Tanzi, Maria Cristina; Freddi, Giuliano

    2013-10-01

    A novel hierarchical textile structure made of silk fibroin from Bombyx mori capable of matching the mechanical performance requirements of anterior cruciate ligament (ACL) and in vitro cell ingrowth is described. This sericin-free, Silk Fibroin Knitted Sheath with Braided Core (SF-KSBC) structure was fabricated using available textile technologies. Micro-CT analysis confirmed that the core was highly porous and had a higher degree of interconnectivity than that observed for the sheath. The in vivo cell colonization of the scaffolds is thus expected to penetrate even the internal parts of the structure. Tensile mechanical tests demonstrated a maximum load of 1212.4±56.4 N (under hydrated conditions), confirming the scaffold's suitability for ACL reconstruction. The absence of cytotoxic substances in the extracts of the SF-KSBC structure in culture medium was verified by in vitro tests with L929 fibroblasts. In terms of extracellular matrix production, Human Periodontal Ligament Fibroblasts (HPdLFs) cultured in direct contact with SF-KSBC, compared to control samples, demonstrated an increased secretion of aggrecan (PG) and fibronectin (FBN) at 3 and 7 days of culture, and no change in IL-6 and TNF-? secretion. Altogether, the outcomes of this investigation confirm the significant utility of this novel scaffold for ACL tissue regeneration. PMID:23910255

  15. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review.

    PubMed

    te Wierike, S C M; van der Sluis, A; van den Akker-Scheek, I; Elferink-Gemser, M T; Visscher, C

    2013-10-01

    This review describes the psychosocial factors that affect recovery following anterior cruciate ligament (ACL) injury and reconstructive surgery in athletes. A systematic search in literature with inclusion and exclusion criteria on PubMed, PsycINFO, and Embase was performed. Articles used in this review were divided in five different parts according to the biopsychosocial model of Wiese-Bjornstal, with the addition of intervention studies. The results showed that a high internal Health Locus of Control and a high self-efficacy were useful cognitive factors to facilitate the recovery. Athletes with a low level of fear of reinjury had the best knee outcome after the injury followed by a reconstruction. In addition, athletes who returned to sport had less fear of reinjury and were more experienced and established athletes compared with athletes who did not return to sport. Furthermore, researchers showed that there was a positive relation between goal setting and adherence, which in turn yielded a positive relation with the outcome of the rehabilitation of an ACL injury. There were several psychosocial interventions that appeared to be facilitating the rehabilitation process. PMID:23121478

  16. The effects of knee joint kinematics on anterior cruciate ligament injury and articular cartilage damage.

    PubMed

    Orsi, Alexander D; Chakravarthy, Srinath; Canavan, Paul K; Peña, Estefanía; Goebel, Ruben; Vaziri, Askhan; Nayeb-Hashemi, Hamid

    2016-04-01

    This study determined which knee joint motions lead to anterior cruciate ligament (ACL) rupture with the knee at 25° of flexion. The knee was subjected to internal and external rotations, as well as varus and valgus motions. A failure locus representing the relationship between these motions and ACL rupture was established using finite element simulations. This study also considered possible concomitant injuries to the tibial articular cartilage prior to ACL injury. The posterolateral bundle of the ACL demonstrated higher rupture susceptibility than the anteromedial bundle. The average varus angular displacement required for ACL failure was 46.6% lower compared to the average valgus angular displacement. Femoral external rotation decreased the frontal plane angle required for ACL failure by 27.5% compared to internal rotation. Tibial articular cartilage damage initiated prior to ACL failure in all valgus simulations. The results from this investigation agreed well with other experimental and analytical investigations. This study provides a greater understanding of the various knee joint motion combinations leading to ACL injury and articular cartilage damage. PMID:26068032

  17. Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction

    PubMed Central

    Roewer, Ben D.; Di Stasi, Stephanie L.; Snyder-Mackler, Lynn

    2011-01-01

    The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers resolve their strength and movement asymmetries within two years after surgery. 26 non-copers were recruited to undergo pre-operative quadriceps strength testing and 3-dimensional gait analysis. Subjects underwent surgery to reconstruct the ligament followed by physical therapy focused on restoring normal range of motion, quadriceps strength, and function. Subjects returned for quadriceps strength testing and gait analysis six months and two years after surgery. Acutely after injury, quadriceps strength was asymmetric between limbs, but resolved six months after surgery. Asymmetric knee angles, knee moments, and knee and hip power profiles were also observed acutely after injury and persisted six months after surgery despite subjects achieving symmetrical quadriceps strength. Two years after surgery, quadriceps strength in the involved limb continued to improve and most kinematic and kinetic asymmetries resolved. These findings suggest that adequate quadriceps strength does not immediately resolve gait asymmetries in non-copers. They also suggest that non-copers have the capacity to improve their quadriceps strength and gait symmetry long after ACL reconstruction. PMID:21592482

  18. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction.

    PubMed

    Kvist, Joanna; Ek, Anna; Sporrstedt, Katja; Good, Lars

    2005-07-01

    Unrestricted participation in sports activities and return to the pre-injury level is often reported as an indicator of the success of ACL reconstruction. The athletes' choice not to return to their pre-injury level may depend on the knee function, but some times, social reasons or psychological hindrances such as fear of re-injury may influence their return to sports. The aim of this study was to investigate whether fear of re-injury due to movement is of significance for returning to previous level of activity in patients who have undergone anterior cruciate ligament reconstruction. The Tampa Scale of Kinesiophobia (TSK), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and some general questions were mailed to 87 patients who underwent ACL reconstruction 3-4 years before the study was conducted. Sixty-two patients (74%) answered the questionnaires (34 men and 28 women). Fifty-three percent of the patients returned to their pre-injury activity level. The patients who did not return to their pre-injury activity level had more fear of re-injury, which was reflected in the TSK. In addition, high fear of re-injury was correlated with low knee-related quality of life. Fear of re-injury must be considered in the rehabilitation and evaluation of the effects of an ACL reconstruction. PMID:15703963

  19. Principal component analysis of knee kinematics and kinetics after anterior cruciate ligament reconstruction.

    PubMed

    Sanford, Brooke A; Zucker-Levin, Audrey R; Williams, John L; Mihalko, William M; Jacobs, Eddie L

    2012-07-01

    This study compared the gait of 10 subjects with unilateral anterior cruciate ligament (ACL) reconstruction to a group of 12 height- and weight-matched control subjects. The analysis was based on knee flexion, adduction, and internal rotation angles and moments. The objective was to use principal component analysis (PCA) to identify knees of the ACL reconstructed subjects that fell outside normal ranges as determined by control subjects. Gait data were collected on all subjects in a motion analysis laboratory. Principal component (PC) models were developed for each gait measure based on the control subjects' data and used to assess gait waveforms of ACL reconstructed subjects. PCA allows analysis of entire gait waveforms for comparisons. In a sample of 10 ACL reconstructed subjects (7 years after surgery, on average), six of the ACL reconstructed knees had not returned to normal following surgery and eight of the contralateral knees functioned differently from controls. A majority of the differences were noted to occur in the abduction-adduction knee moment with corresponding infrequency in the differences seen in abduction-adduction rotation. PCA enabled us to identify subjects with abnormal gait waveforms as outliers relative to the normal control group. PMID:22771153

  20. Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

    PubMed Central

    2013-01-01

    The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

  1. A Novel Small Animal Model of Differential Anterior Cruciate Ligament Reconstruction Graft Strain.

    PubMed

    Ma, Richard; Ju, Xiaodong; Deng, Xiang-Hua; Rodeo, Scott A

    2015-12-01

    The aim of the study was to establish a small animal research model of anterior cruciate ligament (ACL) reconstruction where ACL graft force can be predictably altered with knee motion. Cadaveric rat knees (n?=?12) underwent ACL resection followed by reconstruction. Six knees received anterior (high-tension) femoral graft tunnels and six knees received posterior (isometric) graft tunnels. All the 12 knees and ACL grafts were pretensioned to 3?N at 15 or 45 degrees of knee flexion. ACL graft force (N) was recorded as the knee was ranged from extension to 90-degree flexion. Distinct ACL graft force patterns were generated for a high-tension and isometric femoral graft tunnels. For a high-tension femoral tunnel, the rat ACL graft remained relatively isometric at lower knee flexion angles but increased as the knee was flexed beyond 45 degrees. At 90 degrees, high-tension grafts had significantly greater mean graft tension for both pretensioning at 15 degrees (5.58?±?1.34?N, p?=?0.005) and 45 degrees (6.35?±?1.24?N, p?=?0.001). In contrast, the graft forces for isometric ACL grafts remained relatively constant with knee flexion. Compared with a high-tension ACL grafts, the graft force for grafts placed in an isometric tunnel had significantly lower ACL graft forces at 60, 75, and 90 degrees of knee flexion for both pretensioning at 15 and 45 degrees, respectively. We were able to demonstrate that ACL graft forces in our rat model of ACL reconstruction were sensitive to femoral tunnel position similar to human knees. We were also able to establish two reproducible femoral graft tunnel positions in this small animal model, which yielded significantly different ACL graft tension patterns with knee range of motion. This model would permit further research on how ACL graft tension may affect graft healing. PMID:25343473

  2. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    PubMed Central

    Shervegar, Satish; Nagaraj, Prashanth; Grover, Amit; DJ, Niranthara Ganesh; Ravoof, Abdul

    2015-01-01

    Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively. Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26. Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P<0.001. Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation PMID:26550591

  3. Histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits

    PubMed Central

    Yu, Shao-Bin; Yang, Rong-Hua; Zuo, Zhong-Nan; Dong, Qi-Rong

    2014-01-01

    Polyethylene terephthalate LARS ligament were the remnant of LARS ligament used for repairing posterior cruciate ligament obtained from operation. We want to study histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits. Therefore, we replaced the original ACL with polyethylene terephthalate LARS ligament which was covering with the remnant of ACL in 9 rabbits (L-LARS group), while just only polyethylene terephthalate LARS ligament were transplanted in 3 rabbits (LARS group) with the remnant of ACL. Compared with group LARS, inflammatory cell reaction and foreign body reaction were more significant in group L-LARS. Moreover, electron microscopy investigation showed the tissue near LARS fibers was highly cellular with a matrix of thin collagen fibrils (50-100 nm) in group L-LARS. These above findings suggest the polyethylene terephthalate LARS ligament possess the high biocompatibility, which contributes to the polyethylene terephthalate LARS covered with recipient connective tissues. PMID:25356104

  4. Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Çilo?lu, Osman; Çiçek, Hakan; Y?lmaz, Ahmet; Özalay, Metin; Söker, Gökhan; Leblebici, Berrin

    2014-01-01

    Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture. Conclusion: Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

  5. The Importance of the Intercondylar Notch in Anterior Cruciate Ligament Tears

    PubMed Central

    Fernández-Jaén, Tomás; López-Alcorocho, Juan Manuel; Rodriguez-Iñigo, Elena; Castellán, Fabián; Hernández, Juan Carlos; Guillén-García, Pedro

    2015-01-01

    Background The factors associated with anterior cruciate ligament (ACL) tears are not completely clear. Some studies have shown that patients with a narrow intercondylar notch have a predisposition for ACL tears. Purpose To determine the relationship between the ? angle and intercondylar notch width measurements and ACL tears. Study Design Case-control study; Level of evidence, 3. Methods A total of 530 patients (308 with ACL rupture, 222 with healthy ACLs) were included in this study. The ? angle and intercondylar width were measured from magnetic resonance images (MRIs). Binary logistic regression analysis was performed to determine the influence of the variables on ACL status (normal or torn). Odds ratios (ORs) and their respective 95% CIs were also calculated. Results No significant differences in patient age and the affected knee were found between patients with normal or torn ACLs. The mean ? angle was higher in patients with a torn ACL than in those with an intact one (57.5° ± 5.5° vs 56.2° ± 4.5°; P = .009). Intercondylar width was significantly lower in patients with a torn ACL than in those with an intact one (18.2 ± 3.1 vs 19.5 ± 3.6 mm; P < .001). A highly significant difference between men and women was found for mean intercondylar notch width (19.3 ± 3.3 vs 17.4 ± 3.1 mm; P < .001). In a logistic regression model, sex, intercondylar width, and ? angle were statistically significant when adjusted for age. Conclusion Study results suggest that the ACL tears are associated with a narrow intercondylar notch and a high ? angle, and that tears occur more frequently in men than in women. Clinical Relevance The model proposed in this study could be used by the physician in the medical office as a tool to identify the risk factors that may predispose a patient for a potential ACL tear. PMID:26535388

  6. Determination of patellar ligament and anterior cruciate ligament geometry using MRI.

    PubMed

    Wang, H P; Cui, H K; Yue, W; Yan, R F; Ren, J P; Zhai, Z S; Liang, C H; Yang, R M; Han, D M

    2015-01-01

    Ligament geometry is crucial to surgical treatment success in anterior cruciate ligament (ACL) injury. This study aimed to optimize the MRI technique to elucidate the geometry of the patellar ligament (PL) and ACL in vivo. A 1.5-T superconducting MRI system with a special surface coil and fast spin echo was used to acquire high-resolution T1-weighted images (H-T1WI) of the ACL. The sagittal plane angle was 10° to 15° towards the inner side of the vertical line of the tangent line axis of the femoral intercondylar fossa. The H-T1WI images of the PL were centered at the lower margin of the patella and the center of the tibial tuberosity. The lengths of the PL and ACL were measured using a Radworks 5.1 workstation. ACL and PL lengths were compared between left and right knees and between genders, and left PL length measurements obtained separately by three doctors underwent correlation analysis. The quality of the images satisfied the clinical measurement requirements. The duration of sagittal image acquisition was 2 min and 25 s. The average PL length was 42.20 ± 4.21 and 40.15 ± 4.00 mm, and the average ACL length was 36.98 ± 4.12 and 35.80 ± 4.67 mm, in male and female subjects, respectively. The intraclass correlation coefficients of the PL lengths obtained by the three specialists were greater than 0.997. This MRI technique provides highly stable and repeatable in vivo data of PL and ACL geometry relevant to ACL reconstruction surgery with PL grafts. PMID:26505384

  7. Changes of muscle mechanics associated with anterior cruciate ligament deficiency and reconstruction.

    PubMed

    Hsiao, Shih-Fen; Chou, Pei-Hsi; Hsu, Horng-Chaung; Lue, Yi-Jing

    2014-02-01

    Isometric and isokinetic knee strength deficits were examined on patients with anterior cruciate ligament (ACL) injury before and after ACL reconstruction. Muscle strengths of the uninjured and injured knees were measured from an ACL injured (n = 12) and a control (n = 15) group. Five isometric (10, 30, 50, 70, and 90° of knee flexion) and 5 isokinetic (50, 100, 150, 200, and 250°·s) strengths of quadriceps and hamstrings were measured prereconstruction and postreconstruction (3 and 6 months). Compared with the controls, the uninjured knee showed normal strength and patterns of length-tension and force-velocity relationships. Compared with the uninjured knee, the injured knees showed a generally 25-30% decrease in quadriceps and hamstrings strength with normal patterns of length-tension and force-velocity relationships. By 3 months of reconstruction, weakness of quadriceps of the injured knees was exacerbated, particularly at lengthened positions (? 40% of the uninjured knees at knee flexion 70 and 90°) and at slower velocities (?35% of the uninjured knees at the 50 and 100°·s, p < 0.05), with flattened patterns of mechanical output. By 6 months of reconstruction, the quadriceps of the injured knees still showed significant weakness (?50% of the uninjured knees) in both contraction types (isometric at knee flexion 90° and isokinetic at 50°·s, p < 0.05). The hamstrings of the injured knees had not shown significant changes after reconstruction. A strengthening program placing emphasis on greater knee flexion angles and slower movement speed with sufficient training duration post ACL reconstruction is recommended because of long-lasting and exacerbated weakness during 3 and 6 months postreconstruction. PMID:23669818

  8. Cellular and extracellular matrix changes in anterior cruciate ligaments during human knee aging and osteoarthritis

    PubMed Central

    2013-01-01

    Introduction Anterior cruciate ligament (ACL) degeneration is observed in most osteoarthritis (OA)-affected knee joints. However, the specific spatial and temporal relations of these changes and their association with extracellular matrix (ECM) degeneration are not well understood. The objective of this study was to characterize the patterns and relations of aging-related and OA-associated changes in ACL cells and the ECM. Methods Human knee joints from 80 donors (age 23 through 94) were obtained at autopsy. ACL degeneration was assessed histologically by using a quantitative scoring system. Tissue sections were analyzed for cell density, cell organization, ECM components, ECM-degrading enzymes and markers of differentiation, proliferation, and stem cells. Results Total cell number in normal ACL decreased with aging but increased in degenerated ACL, because of the formation of perivascular cell aggregates and islands of chondrocyte-like cells. Matrix metalloproteinase (MMP)-1, -3, and -13 expression was reduced in aging ACL but increased in degenerated ACL, mainly in the chondrocyte-like cells. Collagen I was expressed throughout normal and degenerated ACL. Collagen II and X were detected only in the areas with chondroid metaplasia, which also expressed collagen III. Sox9, Runt-related transcription factor 2 (Runx2), and scleraxis expression was increased in the chondrocyte-like cells in degenerated ACL. Alpha-smooth muscle actin (?-SMA), a marker of myofibroblasts and the progenitor cell marker STRO-1, decreased with aging in normal ACL. In degenerated ACL, the new cell aggregates were positive for ?-SMA and STRO-1. Conclusions ACL aging is characterized by reduced cell density and activation. In contrast, ACL degeneration is associated with cell recruitment or proliferation, including progenitor cells or myofibroblasts. Abnormally differentiated chondrocyte-like cell aggregates in degenerated ACL produce abnormal ECM and may predispose to mechanical failure. PMID:23406989

  9. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis

    PubMed Central

    Collins, Jamie E.; Yang, Heidi Y.; Goczalk, Melissa G.; Katz, Jeffrey N.; Losina, Elena

    2015-01-01

    Objective Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. Methods We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs) weighted by their precision (1/variance) using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis. Results Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0–5 scale). The summary incidence rate ratio was estimated at 0.731 (95% CI: 0.614, 0.871) for knee injury and 0.493 (95% CI: 0.285, 0.854) for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy. Conclusion The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs. PMID:26637173

  10. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction

    PubMed Central

    Kim, Do Kyung; Hwang, Ji Hye; Park, Won Hah

    2015-01-01

    [Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability. PMID:26504270

  11. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors

    PubMed Central

    Seijas, Roberto; Ares, Oscar; Cuscó, Xavier; Álvarez, Pedro; Steinbacher, Gilbert; Cugat, Ramón

    2014-01-01

    AIM: To evaluate the effect of the application of plasma rich in growth factors (PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament (ACL) tears. METHODS: A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability. Patients with knee instability requiring revision surgery for remnant ACL were selected. PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated. RESULTS: A total of 19 patients were reviewed. Three had a Tegner activity level of 10 and the remaining 16 level 9. The time between the injury and the time of surgery was 5.78 wk (SD 1.57). In total, 81.75% (16/19) returned to the same pre-injury level of sport activity (Tegner 9-10). 17 males and 2 females were treated. The rate of associated injury was 68.42% meniscal lesions and 26.31% cartilage lesions. The KT-1000 values were normalized in all operated cases. One patient was not able to return to sport due to the extent of their cartilage lesions. The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk (SD 1.44) while the 3 patients with Tegner activity level 10 did so in 12.33 wk (SD 1.11). CONCLUSION: With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre- injury level in professional football players. PMID:25035842

  12. Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.

    PubMed

    Iversen, M D; Friden, C

    2009-08-01

    An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills. PMID:18627558

  13. Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking

    PubMed Central

    Varma, Raghav K; Duffell, Lynsey D; Nathwani, Dinesh; McGregor, Alison H

    2014-01-01

    Objectives Prior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups. Participants 12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes. Results No significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12?Nm/kg?m) when compared with those with isolated ACLR (5 participants, 0.1±0.057?Nm/kg?m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait. Conclusions Participants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone. PMID:24898088

  14. Young women's anterior cruciate ligament injuries: an expanded model and prevention paradigm.

    PubMed

    Elliot, Diane L; Goldberg, Linn; Kuehl, Kerry S

    2010-05-01

    Anterior cruciate ligament (ACL) injuries among young female athletes occur at rates three- to eight-times greater than in male competitors and, in general, females experience more sports injuries than males, when balanced for activity and playing time. ACL injuries are a particular concern, as they result in immediate morbidity, high economic costs and may have long-term adverse effects. While several closely monitored ACL injury preventive programmes have been effective, those efforts have not been uniformly protective nor have they achieved widespread use. To date, ACL injury prevention has focused on neuromuscular and anatomical factors without including issues relating more broadly to the athlete. Coincident with greater female sport participation are other influences that may heighten their injury risk. We review those factors, including early single sport specialization, unhealthy dietary behaviours, chronic sleep deprivation and higher levels of fatigue, substance use and abuse, and psychological issues. We augment existing models of ACL injury with these additional dimensions. The proposed expanded injury model has implications for designing injury prevention programmes. High school athletic teams are natural settings for bonded youth and influential coaches to promote healthy lifestyles, as decisions that result in better athletes also promote healthy lifestyles. As an example of how sport teams could be vehicles to address an expanded injury model, we present an existing evidenced-based sport team-centered health promotion and harm reduction programme for female athletes. Widening the lens on factors influencing ACL injury expands the prevention paradigm to combine existing training with activities to promote psychological well-being and a healthy lifestyle. If developed and shown to be effective, those programmes might better reduce injuries and, in addition, provide life skills that would benefit young female athletes both on and off the playing field. PMID:20433210

  15. Orthopedic Practice Patterns Relating to Anterior Cruciate Ligament Reconstruction in Elite Athletes.

    PubMed

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Cvetanovich, Gregory L; Bush-Joseph, Charles; Cole, Brian J; Bach, Bernard R; Verma, Nikhil N

    2015-12-01

    We conducted an online survey of National Hockey League (NHL), Major League Soccer (MLS), and US Olympic/World Cup Ski/Snowboard (Olympic) team orthopedic surgeons to determine practice patterns relating to anterior cruciate ligament (ACL) reconstruction in elite athletes. Of the 94 team orthopedic surgeons surveyed, 47 (50%) responded. Mean (SD) experience as a team physician was 7.73 (5.33) years for NHL, 6.77 (6.64) years for MLS, and 1.14 (0.36) years for Olympic. Mean (SD) number of ACL reconstructions performed in 2012 was 101 (51) for NHL, 78 (38) for MLS, and 110 (105) for Olympic. Overall, 33 surgeons (70.2%) indicated they would use bone-patellar tendon-bone (BPTB) autograft to treat their starting athletes. Twenty-one (44.7%) drilled the femoral tunnel through a transtibial portal, 36.2% through an anteromedial portal, and 12.8% by a 2-incision technique. All the surgeons used a single-bundle technique. Thirty-three (70.2%) did not recommend a brace for their elite athletes during play on return to sport (RTS). Twenty-seven NHL and MLS surgeons (81.8%) recommended RTS only after an athlete has passed a series of RTS tests (eg, Vail, single-leg hop). Most of the NHL, MLS, and Olympic team orthopedic surgeons who were surveyed perform their ACL reconstructions using BPTB autograft, using a single-bundle technique, and through a transtibial portal, and do not require bracing for their athletes returning to sport. Most required their athletes to complete a series of RTS tests before resuming competitive play. PMID:26665248

  16. Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function.

    PubMed

    Tengman, E; Brax Olofsson, L; Nilsson, K G; Tegner, Y; Lundgren, L; Häger, C K

    2014-12-01

    Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23?±?2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P?

  17. Quadriceps neural alterations in anterior cruciate ligament reconstructed patients: A 6-month longitudinal investigation.

    PubMed

    Lepley, A S; Gribble, P A; Thomas, A C; Tevald, M A; Sohn, D H; Pietrosimone, B G

    2015-12-01

    The purpose of this investigation was to evaluate differences in quadriceps corticospinal excitability, spinal-reflexive excitability, strength, and voluntary activation before, 2 weeks post and 6 months post-anterior cruciate ligament reconstruction (ACLr). This longitudinal, case-control investigation examined 20 patients scheduled for ACLr (11 females, 9 males; age: 20.9?±?4.4?years; height:172.4?±?7.5?cm; weight:76.2?±?11.8?kg) and 20 healthy controls (11 females, 9 males; age:21.7?±?3.7 years; height: 173.7?±?9.9?cm; weight: 76.1?±?19.7?kg). Maximal voluntary isometric contractions (MVIC), central activation ratio (CAR), normalized Hoffmann spinal reflexes, active motor threshold (AMT), and normalized motor-evoked potential (MEP) amplitudes at 120% of AMT were measured in the quadriceps muscle at the specific time points. ACLr patients demonstrated bilateral reductions in spinal-reflexive excitability compared with controls before surgery (P?=?0.02) and 2 weeks post-surgery (P???0.001). ACLr patients demonstrated higher AMT at 6 months post-surgery (P???0.001) in both limbs. No MEP differences were detected. Quadriceps MVIC and CAR were lower in both limbs of the ACLr group before surgery and 6 months post-surgery (P???0.05) compared with controls. Diminished excitability of spinal-reflexive and corticospinal pathways are present at different times following ACLr and occur in combination with clinical deficits in quadriceps strength and activation. Early rehabilitation strategies targeting spinal-reflexive excitability may help improve postoperative outcomes, while later-stage rehabilitation may benefit from therapeutic techniques aimed at improving corticospinal excitability. PMID:25693627

  18. In vitro characterization of self-assembled anterior cruciate ligament cell spheroids for ligament tissue engineering.

    PubMed

    Hoyer, M; Meier, C; Breier, A; Hahner, J; Heinrich, G; Drechsel, N; Meyer, M; Rentsch, C; Garbe, L-A; Ertel, W; Lohan, A; Schulze-Tanzil, G

    2015-03-01

    Tissue engineering of an anterior cruciate ligament (ACL) implant with functional enthesis requires site-directed seeding of different cell types on the same scaffold. Therefore, we studied the suitability of self-assembled three-dimensional spheroids generated by lapine ACL ligament fibroblasts for directed scaffold colonization. The spheroids were characterized in vitro during 14 days in static and 7 days in dynamic culture. Size maintenance of self-assembled spheroids, the vitality, the morphology and the expression pattern of the cells were monitored. Additionally, we analyzed the total sulfated glycosaminoglycan, collagen contents and the expression of the ligament components type I collagen, decorin and tenascin C on protein and for COL1A1, DCN and TNMD on gene level in the spheroids. Subsequently, the cell colonization of polylactide-co-caprolactone [P(LA-CL)] and polydioxanone (PDS) polymer scaffolds was assessed in response to a directed, spheroid-based seeding technique. ACL cells were able to self-assemble spheroids and survive over 14 days. The spheroids decreased in size but not in cellularity depending on the culture time and maintained or even increased their differentiation state. The area of P[LA-CL] scaffolds, colonized after 14 days by the cells of one spheroid, was in average 4.57 ± 2.3 mm(2). Scaffolds consisting of the polymer P[LA-CL] were more suitable for colonization by spheroids than PDS embroideries. We conclude that ACL cell spheroids are suitable as site-directed seeding strategy for scaffolds in ACL tissue engineering approaches and recommend the use of freshly assembled spheroids for scaffold colonization, due to their balanced proliferation and differentiation. PMID:25256666

  19. A phenomenological contact model: Understanding the graft-tunnel interaction in anterior cruciate ligament reconstructive surgery.

    PubMed

    Salehghaffari, Shahab; Dhaher, Yasin Y

    2015-07-16

    In this paper, we sought to expand the fidelity of a validated model of the anterior cruciate ligament reconstruction (ACL-R) procedure by incorporating a stick-slip contact model with linear pressure-overclosure relationship at the interface. The suggested model is characterized by three unknown parameters, friction coefficient, shear stress softening and contact stiffness. In the absence of any isolated experiments exploring the graft-tunnel interactions during an aggregate joint load, the calibration data used in this study are derived from a reported biomechanical study. A Bayesian calibration procedure was employed to find the unknown probability distribution function (PDF) of these contact parameters. Initially, the response surface approximations of the predicted graft forces from laxity test simulations was adopted to estimate the likelihood of noisy experimental data reported in the literature. Then, the wide domain of contact parameters was sampled sequentially based on the Marcov Chain Monte Carlo (MCMC) method with acceptance-rejection criteria to search for population of samples in significantly narrower domain of unknown parameters that are associated with the highest occurrence likelihood of noisy experimental data. Our simulations with calibrated contact parameters indicate that pre-tensioning applied at 30° of flexion leads to larger graft force after the joint is fully extended compared to the graft force when the same pre-tensioning force is applied at full extension. Moreover, regardless of the pre-tensioning force, the graft-tunnel contact pressure is larger when the fixation of the graft is performed at full extension, increasing with the pre-tensioning force. PMID:26100464

  20. Anterior cruciate ligament reconstruction with a novel porcine xenograft: the initial Italian experience

    PubMed Central

    ZAFFAGNINI, STEFANO; GRASSI, ALBERTO; MUCCIOLI, GIULIO MARIA MARCHEGGIANI; DI SARSINA, TOMMASO ROBERTI; RAGGI, FEDERICO; BENZI, ANDREA; MARCACCI, MAURILIO

    2015-01-01

    At the current state of the art in anterior cruciate ligament (ACL) reconstruction, multiple techniques have been presented but none has given clearly defined and improved results. One of the main issues concerns the choice of graft. The concept of using xenograft tissue, defined as a graft tissue from one species and destined for implantation in an unlike species, was introduced in order to try to overcome the mechanical and biological concerns associated with synthetic materials and the safety and quality concerns and availability problems of allograft tissue. Xenograft tissue carries the risk of producing an immunological reaction. In order to try to overcome or attenuate the immune response against porcine xenograft tissue, the Z-Process® (Aperion Biologics Inc, San Antonio, Texas, USA) has been developed and used to produce the Z-Lig® family of devices for ACL reconstruction procedures. Z-Lig® is a tendon graft with or without bone blocks, sourced from animal tissue in a manner consistent with what has normally been sourced from human tissue, and processed to overcome anti-Gal-mediated rejection and to attenuate other immunological recognition in humans. All this while ensuring sterility, viral inactivation and preservation of mechanical proprieties appropriate for an ACL reconstruction device. The Z-Lig® device has been tested in skeletally mature monkeys and given interesting and promising results from the preclinical performance and safety profile point of view. On this basis, it was possible to proceed with the first clinical trial involving humans, which gave similar encouraging results. The Z-Lig® device has also been implanted in Italy at the Rizzoli Orthopaedic Institute in Bologna, as a part of international multicenter prospective randomized blinded controlled study aimed at comparing xenograft with allograft tissue. PMID:26605257

  1. Effect of Donor Age on the Proportion of Mesenchymal Stem Cells Derived from Anterior Cruciate Ligaments

    PubMed Central

    Lee, Dae-Hee; Ng, Joanne; Kim, Sang-Beom; Sonn, Chung Hee; Lee, Kyung-Mi; Han, Seung-Beom

    2015-01-01

    The characteristics of anterior cruciate ligament (ACL)-derived mesenchymal stem cells (MSCs), such as proportion and multilineage potential, can be affected by donor age. However, the qualitative and quantitative features of ACL MSCs isolated from younger and older individuals have not yet been compared directly. This study assessed the phenotypic and functional differences in ACL-MSCs isolated from younger and older donors and evaluated the correlation between ACL-MSC proportion and donor age. Torn ACL remnants were harvested from 36 patients undergoing ACL reconstruction (young: 29.67 ± 10.92 years) and 33 undergoing TKA (old: 67.96 ± 5.22 years) and the proportion of their MSCs were measured. The mean proportion of MSCs was slightly higher in older ACL samples of the TKA group than of the younger ACL reconstruction group (19.69 ± 8.57% vs. 15.33 ± 7.49%, p = 0.024), but the proportions of MSCs at passages 1 and 2 were similar. MSCs from both groups possessed comparable multilineage potentiality, as they could be differentiated into adipocytes, osteocytes, and chondrocytes at similar level. No significant correlations were observed between patient age and MSC proportions at passages 0–2 or between age and MSC proportion in both the ACL reconstruction and TKA groups. Multiple linear regression analysis found no significant predictor of MSC proportion including donor age for each passage. Microarray analysis identified several genes that were differentially regulated in ACL-MSCs from old TKA patients compared to young ACL reconstruction patients. Genes of interest encode components of the extracellular matrix (ECM) and may thus play a crucial role in modulating tissue homeostasis, remodeling, and repair in response to damage or disease. In conclusion, the proportion of freshly isolated ACL-MSC was higher in elderly TKA patients than in younger patients with ACL tears, but their phenotypic and multilineage potential were comparable. PMID:25729860

  2. Human patellar tendon stiffness is restored following graft harvest for anterior cruciate ligament surgery.

    PubMed

    Reeves, Neil D; Maganaris, Constantinos N; Maffulli, Nicola; Rittweger, Joern

    2009-05-11

    Minimising post-operative donor site morbidity is an important consideration when selecting a graft for surgical reconstruction of the torn anterior cruciate ligament (ACL). One of the most common procedures, the bone-patellar tendon-bone (BPTB) graft involves removal of the central third from the tendon. However, it is unknown whether the mechanical properties of the donor site (patellar tendon) recover. The present study investigated the mechanical properties of the human patellar tendon in 12 males (mean+/-S.D. age: 37+/-14 years) who had undergone surgical reconstruction of the ACL using a BPTB graft between 1 and 10 years before the study (operated knee; OP). The uninjured contralateral knee served as a control (CTRL). Patellar tendon mechanical properties were assessed in vivo combining dynamometry with ultrasound imaging. Patellar tendon stiffness was calculated from the gradient of the tendon's force-elongation curve. Tendon stiffness was normalised to the tendon's dimensions to obtain the tendon's Young's modulus. Cross-sectional area (CSA) of OP patellar tendons was larger by 21% than CTRL tendons (P<0.01). Patellar tendon stiffness was not significantly different between OP and CTRL tendons, but the Young's modulus was lower by 24% in OP tendons (P<0.01). A compensatory enlargement of the patellar tendon CSA, presumably due to scar tissue formation, enabled a recovery of tendon stiffness in the OP tendons. The newly formed tendon tissue had inferior properties as indicated by the reduced tendon Young's modulus, but it increased to a level that enabled recovery of tendon stiffness. PMID:19268289

  3. A tissue engineering approach to anterior cruciate ligament regeneration using novel shaped capillary channel polymer fibers

    NASA Astrophysics Data System (ADS)

    Sinclair, Kristofer D.

    2009-12-01

    Ruptures of the anterior cruciate ligament (ACL) are the most frequent of injuries to the knee due to its role in preventing anterior translation of the tibia. It is estimated that as many as 200,000 Americans per year will suffer from a ruptured ACL, resulting in management costs on the order of 5 billion dollars. Without treatment these patients are unable to return to normal activity, as a consequence of the joint instability found within the ACL deficient knee. Over the last thirty years, a variety of non-degradable, synthetic fibers have been evaluated for their use in ACL reconstruction; however, a widely accepted prosthesis has been unattainable due to differences in mechanical properties of the synthetic graft relative to the native tissue. Tissue engineering is an interdisciplinary field charged with the task of developing therapeutic solutions for tissue and organ failure by enhancing the natural wound healing process through the use of cellular transplants, biomaterials, and the delivery of bioactive molecules. The capillary channel polymer (CC-P) fibers used in this research were fabricated by melt extrusion from polyethylene terephthalate and polybutylene terephthalate. These fibers possess aligned micrometer scale surface channels that may serve as physical templates for tissue growth and regeneration. This inherent surface topography offers a unique and industrially viable approach for cellular contact guidance on three dimensional constructs. In this fundamental research the ability of these fiber channels to support the adhesion, alignment, and organization of fibroblasts was demonstrated and found to be superior to round fiber controls. The results demonstrated greater uniformity of seeding and accelerated formation of multi-layered three-dimensional biomass for the CC-P fibers relative to those with a circular cross-section. Furthermore, the CC-P geometry induced nuclear elongation consistent with that observed in native ACL tissue. Through the application of uniaxial cyclic strain the mechanical properties of the cell seeded CC-P fiber scaffold systems were shown to improve via the induction of increased cellular proliferation and extracellular matrix synthesis. Finally, unlike many studies examining the effects of cyclic strain on cellular behavior, the CC-P fiber geometry displayed the ability to maintain cellular alignment in the presence of an applied uniaxial cyclic strain.

  4. First-time anterior shoulder dislocations: should they be arthroscopically stabilised?

    PubMed Central

    Sedeek, Sedeek Mohamed; Bin Abd Razak, Hamid Rahmatullah; Ee, Gerard WW; Tan, Andrew HC

    2014-01-01

    The glenohumeral joint is inherently unstable because the large humeral head articulates with the small shadow glenoid fossa. Traumatic anterior dislocation of the shoulder is a relatively common athletic injury, and the high frequency of recurrent instability in young athletes after shoulder dislocation is discouraging to both the patient and the treating physician. Management of primary traumatic shoulder dislocation remains controversial. Traditionally, treatment involves initial immobilisation for 4–6 weeks, followed by functional rehabilitation. However, in view of the high recurrence rates associated with this traditional approach, there has been an escalating interest in determining whether immediate surgical intervention can lower the rate of recurrent shoulder dislocation, improving the patient’s quality of life. This review article aims to provide an overview of the nature and pathogenesis of first-time primary anterior shoulder dislocations, the widely accepted management modalities, and the efficacy of primary surgical intervention in first-time primary anterior shoulder dislocations. PMID:25631890

  5. Applying Cross-Pin System in Both Femoral and Tibial Fixation in Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons

    PubMed Central

    Qi, Wei; Liu, Yujie; Xue, Jing; Li, Haifeng; Wang, Junliang; Qu, Feng

    2015-01-01

    Use of the RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixation of grafts in anterior cruciate ligament reconstruction (ACLR). However, tibial fixation is still limited to the use of interference screws and post fixation, and few surgeons apply the femoral RigidFix system in tibial fixation. Meanwhile, tunnel enlargement is still a problem that affects the outcome of ACLR with hamstring grafts. We have used the femoral RigidFix system in femoral and tibial fixation. The rod top of the guide frame should be placed under the level of the subchondral bone at the proximal end of the tibial tunnel to ensure that the pins will not be inserted into the joint. The pins are inserted through the center of the lateral tibia. Using our technique, the fixation points of the femur and tibia are close to the anterior cruciate ligament insertions, and full contact of the graft with the tunnel wall can be accomplished. On the basis of our preliminary observations and investigation, we are optimistic about the prospect of performing ACLR using the RigidFix system in femoral and tibial fixation. PMID:26697293

  6. Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in National Hockey League Players

    PubMed Central

    Erickson, Brandon J.; Harris, Joshua D.; Cole, Brian J.; Frank, Rachel M.; Fillingham, Yale A.; Ellman, Michael B.; Verma, Nikhil N.; Bach, Bernard R.

    2014-01-01

    Background: Anterior cruciate ligament (ACL) rupture is a significant injury in male National Hockey League (NHL) players. Purpose: To determine (1) the return to sport (RTS) rate in the NHL following ACL reconstruction, (2) performance on RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Study Design: Cohort study; Level of evidence, 3. Methods: NHL players undergoing ACL reconstruction were evaluated. All demographic data were analyzed. Matched controls were selected from the NHL during the same years as those undergoing ACL reconstruction. The “index year” (relative to the number of years of experience in the NHL) in controls was the same as the year that cases underwent ACL reconstruction. RTS and performance in the NHL were analyzed and compared between cases and controls. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Results: A total of 36 players (37 knees) meeting the inclusion criteria underwent ACL reconstruction while in the NHL. Thirty-five players were able to RTS in the NHL (97%), and 1 player returned to the international Kontinental Hockey League. Of the players who RTS in the NHL, 100% were able to RTS the season after ACL reconstruction (mean, 7.8 ± 2.4 months). Length of career in the NHL after ACL reconstruction was 4.47 ± 3.3 years. The revision rate was 2.5%. There were significantly more cases playing in the NHL at 3 (P = .027) and 4 (P = .029) years following surgery compared with controls (index year). After ACL reconstruction, player performance was not significantly different from preinjury performance. Following ACL reconstruction (or index year in controls), cases played significantly more minutes, took more shots, had better shooting percentages, and scored more goals and points than did controls (P < .01 for all). Control players did not significantly outperform cases after ACL reconstruction in any performance measure. Conclusion: There is a high RTS rate in the NHL following ACL reconstruction. All players who RTS did so the season following surgery. Performance following ACL reconstruction was not significantly different from preinjury. Cases performed better than did controls in several performance measures. Controls did not outperform cases in any measured performance variable. PMID:26535359

  7. Mesenchymal stem cells and collagen patches for anterior cruciate ligament repair

    PubMed Central

    Gantenbein, Benjamin; Gadhari, Neha; Chan, Samantha CW; Kohl, Sandro; Ahmad, Sufian S

    2015-01-01

    AIM: To investigate collagen patches seeded with mesenchymal stem cells (MSCs) and/or tenocytes (TCs) with regards to their suitability for anterior cruciate ligament (ACL) repair. METHODS: Dynamic intraligamentary stabilization utilizes a dynamic screw system to keep ACL remnants in place and promote biological healing, supplemented by collagen patches. How these scaffolds interact with cells and what type of benefit they provide has not yet been investigated in detail. Primary ACL-derived TCs and human bone marrow derived MSCs were seeded onto two different types of 3D collagen scaffolds, Chondro-Gide® (CG) and Novocart® (NC). Cells were seeded onto the scaffolds and cultured for 7 d either as a pure populations or as “premix” containing a 1:1 ratio of TCs to MSCs. Additionally, as controls, cells were seeded in monolayers and in co-cultures on both sides of porous high-density membrane inserts (0.4 ?m). We analyzed the patches by real time polymerase chain reaction, glycosaminoglycan (GAG), DNA and hydroxy-proline (HYP) content. To determine cell spreading and adherence in the scaffolds microscopic imaging techniques, i.e., confocal laser scanning microscopy (cLSM) and scanning electron microscopy (SEM), were applied. RESULTS: CLSM and SEM imaging analysis confirmed cell adherence onto scaffolds. The metabolic cell activity revealed that patches promote adherence and proliferation of cells. The most dramatic increase in absolute metabolic cell activity was measured for CG samples seeded with tenocytes or a 1:1 cell premix. Analysis of DNA content and cLSM imaging also indicated MSCs were not proliferating as nicely as tenocytes on CG. The HYP to GAG ratio significantly changed for the premix group, resulting from a slightly lower GAG content, demonstrating that the cells are modifying the underlying matrix. Real-time quantitative polymerase chain reaction data indicated that MSCs showed a trend of differentiation towards a more tenogenic-like phenotype after 7 d. CONCLUSION: CG and NC are both cyto-compatible with primary MSCs and TCs; TCs seemed to perform better on these collagen patches than MSCs. PMID:25815137

  8. Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

    PubMed Central

    Harris, Joshua D.; Erickson, Brandon J.; Bach, Bernard R.; Abrams, Geoffrey D.; Cvetanovich, Gregory L.; Forsythe, Brian; McCormick, Frank M.; Gupta, Anil K.; Cole, Brian J.

    2013-01-01

    Background: Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players. Hypotheses: NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear). Study Design: Case-control. Methods: NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables. Results: Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P < 0.05) regarding games per season; minutes, points, and rebounds per game; and field goal percentage. However, following the index year, controls’ performances declined significantly in games per season; points, rebounds, assists, blocks, and steals per game; and field goal and free throw percentage. Other than games per season, there was no significant difference between cases and controls. Conclusion: There is a high RTS rate in the NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low. Clinical Relevance: There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls. PMID:24427434

  9. A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon

    PubMed Central

    Chahal, Jaskarndip; Lee, Andrew; Heard, Wendell; Bach, Bernard R.

    2013-01-01

    Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices. Purpose: To describe and analyze a single surgeon’s experience with ACLR using bone–patellar tendon–bone (BPTB) as the primary graft choice over a 25-year period. Study Design: Retrospective case series. Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery. Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001). Among primary ACLR cases, 332 patients (18%) underwent concomitant meniscal repair; 14% required revision meniscal surgery. The rate of contralateral ACLR was 6%. Conclusion: This information is useful for patients in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee. The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients. PMID:26535243

  10. Antecedent anterior cruciate ligament reconstruction surgery and optimal duration of supervised physiotherapy.

    PubMed

    Darain, Haider; Alkitani, Abdulhameed; Yates, Christopher; Bailey, Andrea; Roberts, Simon; Coutts, Fiona; Gleeson, Nigel

    2015-12-01

    A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6th, 12th and 24th week post-surgery). The patient scored 30, 56, 60 and 85 on IKDC (maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6th, 12th and 24th week following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12th and 24th week post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session (verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury, immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the patient during the 24 week rehabilitation period. The latter number of physiotherapy sessions was substantially less than the average supervised physiotherapy sessions reported in the literature. PMID:25547235

  11. The effects of levofloxacin on rabbit anterior cruciate ligament cells in vitro

    SciTech Connect

    Deng, Yu; Chen, Biao; Qi, Yongjian; Magdalou, Jacques; Wang, Hui; Chen, Liaobin

    2011-11-15

    Articular cartilage, epiphyseal growth plate and tendons have been recognized as targets of fluoroquinolone-induced connective tissue toxicity. The effects of fluoroquinolones on ligament tissues are still unknown. The aim of this study was to investigate the effects of levofloxacin, a typical fluoroquinolone antibiotic drug, on rabbit anterior cruciate ligament (ACL) cells in vitro. Rabbit ACL cells were treated with levofloxacin at different concentrations (0, 14, 28, 56, 112 and 224 {mu}M) and were assessed to determine the possible cytotoxic effects of levofloxacin on ACL cells. Levofloxacin, with concentrations ranging from 28 to 224 {mu}M, induced dose-dependent ACL cell apoptosis. Characteristic markers of programmed cell death and degenerative changes were identified by electron microscopy in the ACL cells treated with 28 {mu}M of levofloxacin. Moreover, levofloxacin significantly increased the mRNA expression of matrix metalloproteinase 3 (MMP-3) and MMP-13 and decreased the expression of tissue inhibitors of metalloproteinase 1 (TIMP-1) in a concentration-dependent manner; TIMP-3 and collagen type I alpha 1 (Col1A1) mRNA expression was not affected. Immunocytochemical analysis indicated that levofloxacin markedly increased the expression of active caspase-3 within a concentration range of 28 to 224 {mu}M, whereas a clear-cut decrease in Col1A1 expression was found with levofloxacin treatment concentrations of 112 and 224 {mu}M, compared to controls. Our data suggest that levofloxacin has cytotoxic effects on ACL cells characterized by enhanced apoptosis and decreased extracellular matrix, which suggest a potential adverse effect of fluoroquinolones. -- Highlights: Black-Right-Pointing-Pointer Levofloxacin has cytotoxic effect on rabbit ACL cells in vitro. Black-Right-Pointing-Pointer Levofloxacin induces apoptosis in ACL cells. Black-Right-Pointing-Pointer It decreases extracellular matrix by upregulation of matrix degrading enzymes. Black-Right-Pointing-Pointer ACL cells are more susceptible to cytotoxicity by fluoroquinolones. Black-Right-Pointing-Pointer Our study suggests a potential adverse effect of fluoroquinolones.

  12. Anterior cruciate ligament injury in elite football: a prospective three-cohort study.

    PubMed

    Waldén, Markus; Hägglund, Martin; Magnusson, Henrik; Ekstrand, Jan

    2011-01-01

    Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player. PMID:20532869

  13. Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Male Major League Soccer Players

    PubMed Central

    Erickson, Brandon J.; Harris, Joshua D.; Cvetanovich, Gregory L.; Bach, Bernard R.; Bush-Joseph, Charles A.; Abrams, Geoffrey D.; Gupta, Anil K.; McCormick, Frank M.; Cole, Brian J.

    2013-01-01

    Background: Anterior cruciate ligament (ACL) rupture is a significant injury in male Major League Soccer (MLS) players in the United States. Purpose: To determine (1) return-to-sport (RTS) rate in MLS following ACL reconstruction (ACLR), (2) timing of RTS, (3) performance upon RTS, and (4) the difference in RTS and performance between players who underwent ACL reconstruction (ACLR) and controls. Study Design: Case-control study; Level of evidence, 3. Methods: MLS players undergoing ACLR between 1996 and 2012 were evaluated. Player data were extracted from publically available sources. All demographic data were analyzed. A control group of players matched by age, body mass index (BMI), sex, position, performance, and MLS experience (occurred at 2.6 years into career, designated “index year”) was selected from the MLS during the same years as those undergoing ACLR. The RTS and performance in the MLS were analyzed and compared between cases and controls. Student ttests were performed for analysis of within- and between-group variables. Results: A total of 52 players (57 knees) that met inclusion criteria underwent ACLR while in the MLS. Mean player age was 25.6 ± 3.98 years. Forty players were able to resume play (77%). Of the 40 players (45 knees), 38 (43 knees; 95%) resumed play the season following ACLR (mean, 10 ± 2.8 months after surgery). Mean career length in the MLS after ACLR was 4.0 ± 2.8 years. The revision rate was 10%. There was a significant increase in the incidence of ACL tears in the MLS by year (P < .001), and there was a significantly (P= .002) greater number of ACL tears on the left knee as opposed to the right. Performance in the MLS upon RTS after ACLR was not significantly different versus preinjury. There was no significant difference in survival in the MLS between cases and controls after ACLR or index year. The only significant performance differences between cases and controls were that cases had significantly greater shots taken per season (P= .005) and assists (P= .005) than did controls after the index year. Conclusion: There is a high RTS rate in the MLS following ACLR. Nearly all players resumed play the season after surgery. Performance was not significantly different from preinjury. Only 2 performance measures (shots taken and assists) were significantly different between cases and controls. A significantly greater number of ACL tears occur in the left versus the right knee. PMID:26535238

  14. Sex-Specific Predictors of Intra-articular Injuries Observed During Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kluczynski, Melissa A.; Marzo, John M.; Rauh, Michael A.; Bernas, Geoffrey A.; Bisson, Leslie J.

    2015-01-01

    Background: Male patients tend to have more meniscal and chondral injuries at the time of anterior cruciate ligament (ACL) reconstruction than females. No studies have examined sex-specific predictors of meniscal and chondral lesions in ACL-injured patients. Purpose: To identify sex-specific predictors of meniscal and chondral lesions, as well as meniscal tear management, in patients undergoing ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from 689 patients (56.2% males) undergoing ACL reconstruction between 2005 and 2014. Predictors of meniscal tears, meniscal tear management, and chondral injuries were determined using multivariate logistic regression models stratified by sex. Predictors were age, body mass index (BMI; 25-29.99 and ?30 vs ?24.99 kg/m2), mechanism (contact vs noncontact) and type (high-impact sports [basketball, football, soccer, and skiing] and other sports vs not sports-related) of injury, interval from injury to surgery (?6 vs >6 weeks), and instability episodes (vs none). Odds ratios and 95% CIs were reported. Results: Males had more lateral (46% vs 27.8%; P < .0001) and medial (40.2% vs 31.5%; P = .01) meniscal tears, as well as more lateral (72.1% vs 27.9%; P < .0001) and medial (61.4% vs 38.6%; P = .01) meniscectomies than females. For males, age predicted chondral injuries and medial meniscectomy; BMI ?30 kg/m2 predicted medial meniscal tears; high-impact and other sports predicted medial meniscal tears, medial meniscectomies, and medial meniscal repairs; injuries ?6 weeks from surgery predicted lateral meniscal repairs; and instability episodes predicted medial meniscal tears, medial tears left in situ, medial meniscectomies, and medial meniscal repairs. For females, age predicted chondral injuries, BMI ?30 kg/m2 predicted lateral meniscectomies and repairs, and instability episodes predicted medial meniscectomies. Conclusion: Sex differences were observed. For males, predictors included age, BMI, sports-related injuries, injuries ?6 weeks from surgery, and instability episodes. For females, predictors included age, BMI, and instability episodes. PMID:26535384

  15. Neuromuscular Evaluation With Single-Leg Squat Test at 6 Months After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hall, Michael P.; Paik, Ronald S.; Ware, Anthony J.; Mohr, Karen J.; Limpisvasti, Orr

    2015-01-01

    Background: Criteria for return to unrestricted activity after anterior cruciate ligament (ACL) reconstruction varies, with some using time after surgery as the sole criterion—most often at 6 months. Patients may have residual neuromuscular deficits, which may increase the risk of ACL injury. A single-leg squat test (SLST) can dynamically assess for many of these deficits prior to return to unrestricted activity. Hypothesis: A significant number of patients will continue to exhibit neuromuscular deficits with SLST at 6 months after ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients using a standardized accelerated rehabilitation protocol at their 6-month follow-up after primary ACL reconstruction were enrolled. Evaluation included bilateral SLST, single-leg hop distance, hip abduction strength, and the subjective International Knee Documentation Committee (IKDC) score. Results: Thirty-three patients were enrolled. Poor performance of the operative leg SLST was found in 15 of 33 patients (45%). Of those 15 patients, 7 (45%) had concomitant poor performance of the nonoperative leg compared with 2 of 18 patients (11%) in those who demonstrated good performance in the operative leg. The poor performers were significantly older (33.6 years) than the good performers (24.2 years) (P = .007). Those with poor performance demonstrated decreased hip abduction strength (17.6 kg operative leg vs 20.5 kg nonoperative leg) (P = .024), decreased single-leg hop distance (83.3 cm operative leg vs 112.3 cm nonoperative leg) (P = .036), and lower IKDC scores (67.9 vs 82.3) (P = .001). Conclusion: Nearly half of patients demonstrated persistent neuromuscular deficits on SLST at 6 months, which is when many patients return to unrestricted activity. Those with poor performance were of a significantly older age, decreased hip abduction strength, decreased single-leg hop distance, and lower IKDC subjective scores. Clinical Relevance: The SLST can be used to identify neuromuscular risk factors for ACL rupture. Many patients at 6 months have persistent neuromuscular deficits on SLST. Caution should be used when using time alone to determine when patients can return to unrestricted activity. PMID:26665033

  16. Risk for Revision After Anterior Cruciate Ligament Reconstruction Is Higher Among Adolescents

    PubMed Central

    Faunø, Peter; Rahr-Wagner, Lene; Lind, Martin

    2014-01-01

    Background: The number of children and adolescents with anterior cruciate ligament (ACL) reconstructions is increasing, and disturbing reports on high rerupture rates in this group have been noted. Purpose: To describe the outcome of ACL reconstruction in children and adolescents based on data from the Danish Knee Ligament Reconstruction Registry (DKRR). Study Design: Cohort study; Level of evidence, 3. Methods: Data were retrieved from the DKRR, a national population-based registry. The analysis was based on a population of 14,806 ACL-reconstructed patients. The outcome was evaluated using risk of ACL revision, subjective outcome score (Knee injury and Osteoarthritis Outcome Score [KOOS]), Tegner function score, and objective knee laxity. Three age groups were defined (A, <13 years; B, 13-15 years; and C, 15-20 years) and compared with D, patients ?20 years (adults). There were 95 patients in group A, 327 in B, 2888 in C, and 11,496 in D. Results: There was a significantly increased risk of revision surgery in the age groups B (6.7%) and C (4.9%) compared with the adults in group D (2.0%). Objective knee laxity did not differ between the 4 groups. Groups A, B, and C had a higher score on the combined KOOS symptoms, pain, sport, and quality of life subscales (KOOS4; 79.6, 76.6, and 73.1, respectively) compared with the adults (69.7). Group B had higher KOOS quality of life (76.6) and sports (71.1) scores than did group C (73.1 and 66.4, respectively). The Tegner activity score did not differ between the 4 groups. No impact of the use of extracortical graft fixation was detected in the youngest age group. Conclusion: Study results indicated an increased risk of graft failure in patients between 13 and 20 years of age. This is in contrast to the better subjective and equal objective knee score found in the same age groups. Clinical Relevance: The new knowledge about the high revision rate among ACL-reconstructed teenagers is important for evidence-based preoperative information of ACL patients and their parents. PMID:26535272

  17. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. PMID:18716694

  18. Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury

    PubMed Central

    Wellsandt, Elizabeth; Gardinier, Emily S.; Manal, Kurt; Axe, Michael J.; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2015-01-01

    Background Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Hypothesis Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Study Design Case-control study; Level of evidence, 3. Methods Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Results Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs ?0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: ?0.001 ± 0.032 N·m·s/kg·m [nonOA] vs ?0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs ?0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). Conclusion Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction. PMID:26493337

  19. Autologous Hamstring Anterior Cruciate Ligament Graft Failure Using the Anteromedial Portal Technique With Suspensory Femoral Fixation

    PubMed Central

    Galdi, Balazs; Reyes, Allan; Brabston, Eugene W.; Levine, William N.

    2015-01-01

    Background: The anteromedial portal technique for drilling of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction has been advocated by many surgeons as allowing improved access to the anatomical footprint. Furthermore, suspensory fixation of soft tissue grafts has become popularized because of complications associated with cross-pin fixation. Concerns regarding the use of both have recently arisen. Purpose: To raise awareness of the increased risk of graft failure when using the anteromedial portal technique with suspensory femoral fixation during ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: From November 1998 to August 2012, a total of 465 primary ACL reconstructions were performed using quadrupled hamstring autograft tendons, with drilling of the femoral tunnel performed via the transtibial portal. Graft fixation on the femur was achieved with cross-pin fixation, while interference screw fixation was used on the tibia. From September 2012 to October 2013, there were 69 reconstructions performed through an anteromedial portal. While there was no change in graft choice, a change was made to using suspensory femoral fixation. No other surgical or postoperative rehabilitation changes were made. Results: During the 14-year period in which ACL reconstructions were performed via the transtibial portal and with cross-pin fixation, 2 graft failures (0.4% failure rate) were reported. After switching to the anteromedial portal with suspensory fixation, 7 graft failures (10.1% failure rate) were reported over a 13-month period. These were 5 male and 2 female patients, with a mean age of 18.8 years—all elite athletes. The same surgical technique was used in all patients, and all patients had at least an 8 mm–diameter graft. Patients were cleared to return to sport at an average of 8.4 months postoperatively, after completing functional performance tests. Of the 7 patients, 6 sustained a rerupture of the graft within 2 weeks of returning to full competition. The final patient sustained a rerupture 10 months after being cleared to play. Conclusion: Compared with the transtibial technique with cross-pin graft fixation, there is an increased risk of graft failure when performing autologous hamstring ACL reconstructions using the anteromedial portal technique with cortical suspensory fixation. PMID:26535370

  20. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

    2013-01-01

    Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes. PMID:23041233

  1. Reactive Muscle Firing of Anterior Cruciate Ligament-Injured Females During Functional Activities

    PubMed Central

    Swanik, C. Buz; Lephart, Scott M.; Giraldo, Jorge L.; DeMont, Richard G.; Fu, Freddie H.

    1999-01-01

    Objective: The high incidence of noncontact anterior cruciate ligament (ACL) injuries in females has attracted research to investigate the capacity of muscles to reflexively protect the knee joint from capsuloligamentous injury. Numerous reflex pathways link mechanoreceptors in the ACL with contractile fibers in the quadriceps and hamstring muscles. Loads placed on the ACL modify reactive muscle activity through the feed-back process of neuromuscular control and are critical for dynamic muscular stabilization. Noncontact ACL injuries may be the result of aberrations in reactive muscle firing patterns. Therefore, compensatory muscle activation strategies must be employed if functional stability is to be restored after injury or surgical reconstruction. The purpose of our study was to compare the amplitude of reactive muscle activity in females with ACL-deficient (ACLD), ACL-reconstructed (ACLR), and control knees during functional activities. Design and Setting: Female volunteer subjects were stratified into groups based on the status of their ACLs. Each subject performed 4 functional activities, bilaterally, during a single test session. Subjects: Twenty-four female subjects participated in this study (ACLD = 6, ACLR = 12, control = 6). Measurements: Integrated electromyographic (IEMG) data were collected with surface electrodes from the vastus medialis, vastus lateralis, medial hamstring, and lateral hamstring during downhill walking (15°, 0.92 m/s), level running (2.08 m/s), and hopping and landing from a jump (20.3 cm). IEMG was normalized to the mean amplitude of 3 to 6 consecutive test repetitions. The mean area and peak IEMG of a 250-millisecond period after ground contact was used to represent reactive muscle activity. Side-to-side differences were determined using dependent t tests, and group differences were determined using a one-way analysis of variance. Results: During running, the ACLD group demonstrated significantly greater area and peak IEMG activity in the medial hamstring in comparison with the ACLR group and greater peak activity in the lateral hamstring when compared with the control group. The ACLD group also demonstrated greater peak activity in the vastus medialis and a smaller area of IEMG activity in the lateral hamstring than the control group during running. During landing, the ACLD group demonstrated significantly less area of IEMG activity in the vastus lateralis when compared with the control group. No significant differences were identified between the ACLR and control groups, nor were side-to side differences revealed. Conclusions: Our results suggest that adaptations occur in the reactive muscle activity of ACLD females during functional activities. Strategies to minimize the anterior tibial translation in response to joint loading included increased hamstring activity and quadriceps inhibition. The reactive muscle activity exhibited in ACLD subjects is presumably an attempt to regain functional stability through the dynamic restraint mechanism. The absence of side-to-side differences suggests that these adaptations occur bilaterally after ACL injury. ImagesFigure 1.Figure 2.Figure 2.Figure 3.Figure 4.Figure 5. PMID:16558554

  2. New sonographically-guided test for anterior knee instability – preliminary report

    PubMed Central

    Podgórski, Micha?; Stefa?czyk, Ludomir; Dom?alski, Marcin

    2014-01-01

    Aim of the study Ultrasound examination is widely used in orthopedic diagnostics, however sonographic evaluation of traumatic anterior cruciate ligament insufficiency is still inadequate. Aim of this study is to evaluate diagnostic capability of a new sonographically-guided test for diagnosing complete anterior cruciate ligament insufficiency. Material and methods In 47 patients, with suspicion of unilateral anterior cruciate ligament injury (based on magnetic resonance imaging), the sonographically-guided test for anterior instability was performed. The translation of the intercondylar eminence against the patellar tendon was measured in both knees. Afterwards all patients underwent arthroscopy. Results In 37 patients, with arthroscopically confirmed complete anterior cruciate ligament insufficiency, the mean anterior knee translation was 8.3 mm (SD = 2.8) in affected knee vs. 3 mm (SD = 1.1) in uninjured knee (p < 0.001). In 10 patients with no anterior cruciate ligament insufficiency the difference between body sides was not significant (2.6 mm, SD = 1.4 in injured knee vs. 2.5 mm, SD = 1.1 in uninjured joint; p < 0.7753). Conclusions The proposed test supports the clinician with fast and non-invasive examination that can facilitate evaluation of anterior knee instability.

  3. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

    PubMed Central

    Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

    2015-01-01

    Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise. PMID:26557277

  4. Anterior cruciate ligament tears for the primary care sports physician: what to know on the field and in the office.

    PubMed

    Heard, Wendell Mr; VanSice, Wade C; Savoie, Felix H

    2015-11-01

    Anterior cruciate ligament (ACL) injuries are relatively common and can lead to knee dysfunction. The classic presentation is a non-contact twisting injury with an audible pop and the rapid onset of swelling. Prompt evaluation and diagnosis of ACL injuries are important. Acute treatment consists of cessation of the sporting activity, ice, compression, and elevation with evaluation by a physician familiar with ACL injuries and their management. The diagnosis is made with the use of patient history and physical examination as well as imaging studies. Radiographs may show evidence of a bony injury. MRI confirms the diagnosis and evaluates the knee for concomitant injuries to the cartilage, menisci and other knee ligaments. For active patients, operative treatment is often recommended while less-active patients may not require surgery. The goal of this review is to discuss the diagnosis of an ACL injury and provide clear management strategies for the primary-care sports medicine physician. PMID:26559706

  5. Panax notoginseng saponins promote wound repair of anterior cruciate ligament through phosphorylation of PI3K, AKT and ERK

    PubMed Central

    Yu, Lu; Xie, Jingwei; Xin, Na; Wang, Zhanyou

    2015-01-01

    Panax notoginseng saponins (PNS) are components derived from Chinese herb panax notoginseng and play important roles in the cure of wounds. However, how PNS plays this function is still unclear. In this study, we used MTT assay, wound healing assay, western blot, quantitative real time PCR and enzyme-linked immunosorbent assay to detect the effects of PNS on the proliferation, migration and expression of collagen and fibronectin of anterior cruciate ligament (ACL) fibroblasts as well as the underlying mechanism. We found that PNS promoted the proliferation and migration of ACL fibroblasts and increased the expression levels of collagen and fibronectin. Further mechanism study indicates that PNS might play its function through the phosphorylation of PI3K, AKT and ERK. This study provides a possible mechanism for the function of PNS and lays foundation for further study on the function of panax notoginseng. PMID:25755732

  6. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    PubMed

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

  7. Effects of acceleration training 24 weeks after anterior cruciate ligament reconstruction on proprioceptive and dynamic balancing functions

    PubMed Central

    An, Keun Ok; Park, Gi Duck; Lee, Joong-Chul

    2015-01-01

    [Purpose] The present study aimed to investigate whether the effects of rehabilitation exercise performed after anterior cruciate ligament reconstruction on proprioceptive sensory and dynamic balancing functions differ between males and females. [Subjects and Methods] Eighteen subjects aged between 20–30?years enrolled in this study. The ages did not significantly differ between the males and females. The rehabilitation exercise program was performed three times per week for 12 weeks (3 months), and was initiated immediately after anterior cruciate ligament reconstruction. Thereafter, the patients visited the hospital once per week to perform rehabilitation exercise during weeks 12–24 (3–6 months), and education on self-exercise and assessments were conducted during the visits. Self-exercise was performed two times per week according to the determined program. [Results] The extension active joint position sense, extension passive joint position sense, and flexion passive joint position sense of the affected and unaffected knees did not show any interaction effects between the measurement periods or between the groups. In the case of the affected knee, the results of two-way repeated-measures analysis of variance showed no significant difference between the measurement periods or between the groups; moreover, no, interaction effects were observed between the measurement periods or between the groups. In the case of the unaffected knee, although no significant difference was observed between the measurement periods, significant differences were observed between the groups. [Conclusion] In conclusion, this study revealed that most knee rehabilitation exercise training programs can be applied to both genders during the recovery period after ACL reconstruction, except for the knee rotational feedback/feedforward function exercise that may exhibit different effects based on the gender. PMID:26504302

  8. Arthroscopic Identification of the Anterolateral Ligament of the Knee.

    PubMed

    Sonnery-Cottet, Bertrand; Archbold, Pooler; Rezende, Fernando C; Neto, Ayrton M; Fayard, Jean-Marie; Thaunat, Mathieu

    2014-06-01

    Intense interest has focused on the recent description of the anterolateral ligament of the knee. Advancing knowledge of its anatomy and function is leading to a realization of its importance in the rotatory control of the tibia in anterior cruciate ligament injuries. Reconstruction of this structure will increasingly become an important goal during anterior cruciate ligament reconstruction. However, preoperative assessment of this ligament is difficult. Clinical assessment of rotatory laxity has poor reproducibility, and it is difficult to define using current imaging techniques. This article is the first to describe a safe and reproducible arthroscopic technique to allow identification and examination of the anterolateral ligament of the knee. With the knee at 90° of flexion, the arthroscope is introduced through the anterolateral portal to allow clear visualization of the lateral gutter. Under direct vision, an accessory portal is made over the inferior limit of the lateral gutter. A shaver is then introduced through this portal and used to debride this synovial recess and define the anterolateral ligament. This allows the surgeon to examine the integrity of the anterolateral ligament, in particular its femoral insertion. If required, this additional information can facilitate the performance of a more accurate and effective extra-articular reconstruction. PMID:25126509

  9. Characterization of Biochemical Cartilage Change After Anterior Cruciate Ligament Injury Using T1? Mapping Magnetic Resonance Imaging

    PubMed Central

    Osaki, Kanji; Okazaki, Ken; Takayama, Yukihisa; Matsubara, Hirokazu; Kuwashima, Umito; Murakami, Koji; Doi, Toshio; Matsuo, Yoshio; Honda, Hiroshi; Iwamoto, Yukihide

    2015-01-01

    Background: Patients with anterior cruciate ligament (ACL)–injured knees are at an increased risk of posttraumatic osteoarthritis (OA). OA changes secondary to ACL injuries have many variations, and when and where early cartilage degenerative change begins has not yet been established. Purpose: To characterize the location of cartilage degeneration after ACL injury associated with time since injury using T1rho (T1?) mapping. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In this study, 49 knees with ACL injuries and 14 normal knees from uninjured volunteers were imaged with a 3.0-T magnetic resonance scanner. Three regions of interest (ROIs) were defined in the cartilage at the weightbearing area of the femoral condyles (anterior, middle, and posterior zones). Two ROIs were defined in the tibial plateau (anterior and posterior zones). The T1? values within the ROIs were measured. Patients were allocated into 3 groups based on time since injury: <12 weeks (group A; 28 patients), 12 weeks to 2 years (group B; 14 patients), and >2 years to 5 years (group C; 7 patients). Results: Mean T1? values were significantly greater in the anterior and middle ROIs of the medial femoral condyle in group C compared with those in other groups (P < .05). Patients with medial meniscus injury, for whom the time since injury was ?12 weeks, exhibited significantly greater T1? values in the middle areas of the medial femoral condyle versus normal knees and ACL-injured knees without medial meniscus injury. Conclusion: The risk of cartilage degeneration in the area of the femoral condyle that contacts the tibia during small degrees of flexion increased when the time since injury was longer than 2 years. In addition, medial meniscus injury was associated with cartilage degeneration at the medial femoral condyle in the chronic phase. Clinical Relevance: Cartilage degeneration occurs more than 2 years after ACL injury and increases with medial meniscus injury. Early intervention may be desirable for meniscus injury. PMID:26672435

  10. Lack of Correlation between Dynamic Balance and Hamstring-to-Quadriceps Ratio in Patients with Chronic Anterior Cruciate Ligament Tears

    PubMed Central

    Lee, Jin-Hyuck; Jeong, Hye-Jin; Lee, Seok-Joo

    2015-01-01

    Purpose The purpose of this study was to evaluate the quadriceps and hamstring muscle strength and hamstring-to-quadriceps (HQ) ratio, as well as the relationships of these parameters with dynamic balance, in patients with anterior cruciate ligament (ACL) rupture. Materials and Methods We compared 25 patients diagnosed with chronic unilateral ACL tears and 25 age-matched healthy volunteers. The maximal torque of the quadriceps and hamstring and dynamic balance were measured. Results Although the isokinetic maximal peak torques were about 50% lower in the quadriceps (57%, p<0.001) and hamstring (56%, p=0.001) muscles in the chronic ACL tear group than in the control group, their HQ ratios were similar (56%±17% vs. 58%±6%, p=0.591). HQ ratio was significantly correlated with anterior-posterior stability index (r=-0.511, p=0.021) and overall stability index (r=-0.476, p=0.034) in control group, but these correlations were not observed in chronic ACL tear group. Conclusions Thigh muscle strength was about 50% lower in the chronic ACL tear group than in the control group, but the HQ ratio was similar. The dynamic balance of the knee was not influenced by thigh muscle strength but was influenced by HQ ratio in healthy young individuals. However, HQ ratio was not correlated with dynamic knee balance in chronic ACL tear patients. PMID:26060609

  11. The Relationships Among Sagittal-Plane Lower Extremity Moments: Implications for Landing Strategy in Anterior Cruciate Ligament Injury Prevention

    PubMed Central

    Shimokochi, Yohei; Yong Lee, Sae; Shultz, Sandra J; Schmitz, Randy J

    2009-01-01

    Context: Excessive quadriceps contraction with insufficient hamstrings muscle cocontraction has been shown to be a possible contributing factor for noncontact anterior cruciate ligament (ACL) injuries. Assessing the relationships among lower extremity internal moments may provide some insight into avoiding muscle contraction patterns that increase ACL injury risk. Objective: To examine the relationships of knee-extensor moment with ankle plantar-flexor and hip-extensor moments and to examine the relationship between knee moment and center of pressure as a measure of neuromuscular response to center-of-mass position. Design: Cross-sectional study. Setting: Applied Neuromechanics Research Laboratory. Patients or Other Participants: Eighteen healthy, recreationally active women (age ?=? 22.3 ± 2.8 years, height ?=? 162.5 ± 8.1 cm, mass ?=? 57.8 ± 9.3 kg). Intervention(s): Participants performed a single-leg landing from a 45-cm box onto a force plate. Kinetic and kinematic data were collected. Main Outcome Measure(s): Pearson product moment correlation coefficients were calculated among the net peak knee-extensor moment (KEMpk), sagittal-plane ankle (AM) and hip (HM) net internal moments, and anterior-posterior center of pressure relative to foot center of mass at KEMpk (COP). Results: Lower KEMpk related to both greater AM (r ?=? ?0.942, P < .001) and HM (r ?=? ?0.657, P ?=? .003). We also found that more anterior displacement of COP was related to greater AM (r ?=? ?0.750, P < .001) and lower KEMpk (r ?=? 0.618, P ?=? .006). Conclusions: Our results suggest that participants who lean the whole body forward during landing may produce more plantar-flexor moment and less knee-extensor moment, possibly increasing hip-extensor moment and decreasing knee-extensor moment production. These results suggest that leaning forward may be a technique to decrease quadriceps contraction demand while increasing hamstrings cocontraction demand during a single-leg landing. PMID:19180216

  12. Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

    PubMed Central

    2010-01-01

    Background The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation. Methods In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw. In eight knees a wedge shaped bone block with an 11 mm by 10 mm base without a screw was used. In a further eight knees a similar wedge with a 13 mm by 10 mm base was used. Each specimen used a standard 10 mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure. Results Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p = 0.16), or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation) (P = 0.35). Conclusions Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation. PMID:20813059

  13. Biomechanical jumping differences among elite female handball players with and without previous anterior cruciate ligament reconstruction: a novel inertial sensor unit study.

    PubMed

    Setuain, Igor; Millor, Nora; González-Izal, Miriam; Gorostiaga, Esteban M; Gómez, Marisol; Alfaro-Adrián, Jesús; Maffiuletti, Nicola A; Izquierdo, Mikel

    2015-09-01

    Persistent biomechanical and jumping capacity alterations have been observed among female athletes who have sustained anterior cruciate ligament (ACL) injuries. The purpose of this study was to examine if biomechanical jumping differences persist among a cohort of elite female handball players with previous ACL reconstruction several years after return to top-level competition. In order to achieve this goal, a direct mechanics simplified analysis by using a single Inertial Sensor Unit (IU) was used. Twenty-one elite female (6 anterior cruciate ligament reconstructed and 15 uninjured control players) handball players were recruited and evaluated 6.0 ± 3.5 years after surgical anterior cruciate ligament reconstruction. Bilateral and unilateral vertical jumps were performed to evaluate the functional performance and a single inertial sensor unit was employed in order to collect 3D acceleration and 3D orientation data. Previously ACL-reconstructed analysed athletes demonstrated significant (p < 0.05) alterations in relation to the three-dimensional axis (X-Y-Z) supported accelerations and differing jump phase durations, including jumping performance values, in both bilateral and unilateral jumping manoeuvres several years after ACL reconstruction. Identification of the encountered deficits through the use of an IU devise could provide clinicians with a new reliable tool for movement analysis in a clinical setting. PMID:26158388

  14. Arthroscopic Surgery to Replace a Young Athlete's ACL

    MedlinePLUS

    ... young patient. Though often seen with pro athletes, anterior cruciate ligament damage occurs often in young people and more ... MD: Certainly athletes do usually require ACL, or anterior cruciate ligament, reconstructions, but also anybody that just wants to ...

  15. Influence of functional knee bracing on the isokinetic and functional tests of anterior cruciate ligament deficient patients.

    PubMed

    Mortaza, Niyousha; Abu Osman, Noor Azuan; Jamshidi, Ali Ashraf; Razjouyan, Javad

    2013-01-01

    Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in Anterior cruciate ligament(ACL)-injured patients. However, many athletes might refrain from wearing the braces because of the fear of performance hindrance in the playing field. The aim of this study was to examine the effect of three functional knee brace/sleeves upon the isokinetic and functional performance of ACL-deficient and healthy subjects. Six anterior cruciate ligament deficient (29.0 ± 5.3 yrs., 175.2 ± 5.4 cm, and 73.0 ± 10.0 kg) and six healthy male subjects (27.2 ± 3.7 yrs., 176.4 ± 6.4 cm, and 70.3 ± 6.9 kg) were selected. The effect of a custom-made functional knee brace, and two neoprene knee sleeves, one with four metal supports and one without support were examined via the use of isokinetic and functional tests in four sets (non-braced,wearing functional knee brace,and wearing the sleeves). Cross-over hop and single leg vertical jump test were performed and jump height, and hop distance were recorded. Peak torque to body weight ratio and average power in two isokinetic velocities(60°.s(-1),180°.s(-1)) were recorded and the brace/sleeves effect was calculated as the changes in peak torque measured in the brace/sleeves conditions, expressed as a percentage of peak torque measured in non-braced condition. Frequency content of the isokinetic torque-time curves was also analyzed. Wilcoxon signed rank test was used to compare the measured values in four test conditions within each control and ACL-deficient group,and Mann-Whitney U test was used for the comparison between the two groups. No significant differences in peak torque, average power, torque-time curve frequency content, vertical-jump and hop measurements were found within the experimental and the non-braced conditions (p>0.05). Although the examined functional knee brace/sleeves had no significant effect on the knee muscle performance, there have been some enhancement regarding the extension peak torques and power generating capacity of the ACL-deficient subjects that could be helpful in reducing the bilateral asymmetry in these patients. PMID:23717593

  16. A between sex comparison of anterior-posterior knee laxity after anterior cruciate ligament reconstruction with patellar tendon or hamstrings autograft: a systematic review.

    PubMed

    Paterno, Mark V; Weed, Ashley M; Hewett, Timothy E

    2012-02-01

    Anterior-posterior (AP) knee laxity after anterior cruciate ligament (ACL) reconstruction may differ between sexes for different graft types. Females may experience an increase in AP knee laxity following an ACL reconstruction with a hamstrings graft, which is not seen in males with a hamstrings graft or in males or females with a bone-patellar tendon-bone (BTB) graft. The hypothesis of this review is sex differences in AP knee laxity and this will be identified in patients who undergo an ACL reconstruction with a hamstrings graft, while no sex differences will be observed in patients who have an ACL reconstruction with a BTB graft. A systematic search was performed in PubMed, CINAHL and SPORTDiscus. Inclusion criteria were articles published in the English language that studied human subjects who underwent an ACL reconstruction with a BTB or hamstrings autograft, and the presence of a sex comparison on outcome measures including side-to-side difference in AP knee laxity. Methodological quality was assessed using a Modified Coleman Methodology Score. Eleven cohort studies met the inclusion criteria. Six investigated sex differences in both hamstrings and BTB grafts. Three only investigated BTB grafts and two only investigated hamstrings grafts. These studies consistently reported increases in AP knee laxity in females after an ACL reconstruction with a hamstrings graft that was not observed in the other cohorts. This systematic review indicates that female patients have greater AP knee laxity following an ACL reconstruction with a hamstrings autograft compared with males with a similar procedure, and both females and males following an ACL reconstruction with a BTB autograft. These results are derived from lower level evidence, as no randomized control trials have attempted to answer this question. Future studies need to rigorously address this clinical question to confirm the results currently in the literature. PMID:22260514

  17. Gait modification strategies of trunk over left stance phase in patients with right anterior cruciate ligament deficiency

    PubMed Central

    Shi, Dongliang; Li, Nannan; Wang, Yubin; Jiang, Shuyun; Li, Jinglong; Zhu, Wenhui

    2015-01-01

    Purpose: To investigate the gait modification strategies of trunk over left stance phase in patients with right anterior cruciate ligament deficiency (ACL-D). Methods: Thirty-six patients with right ACL-D and thirty-six health subjects (control) were recruited to undergo a 3-dimensional (3D) gait analysis. Coordinate data from 26 reflective markers positioned on the body surface of participants were recorded with a 3D optical video motion capture system, as they walked on the ground, ascended and descended a custom-built staircase. Angle changes in the 3-planes under different walking conditions were analyzed. Results: There were statistically significant differences between the two groups in the trunk at the transverse plane angle in most measurements. With the walk pattern of stair descent, the trunk at all 3-plane angles, at the maximum value of the left knee sagittal/coronal/transverse plane moment, was significantly different between the two groups (P ? 0.03). Conclusions: Our findings suggested that special gait modification of trunk is apparent over stance of left (healthy) side in patients with right ACL-D. The results of this study may supply more insight with respect to improving the diagnosis and rehabilitation of ACL-D. This information may also be helpful for a better use of walk and stair tasks as part of a rehabilitation program and provide a safe guideline for the patients. PMID:26550279

  18. Anterior cruciate ligament injury about 20 years post-treatment: A kinematic analysis of one-leg hop.

    PubMed

    Tengman, E; Grip, H; Stensdotter, Ak; Häger, C K

    2015-12-01

    Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23?±?2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACLR ) and 37 with physiotherapy alone (ACLPT ). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACLR had larger external rotation of the injured leg at landing. ACLPT showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACLR . PMID:25728035

  19. Runx2-Modified Adipose-Derived Stem Cells Promote Tendon Graft Integration in Anterior Cruciate Ligament Reconstruction.

    PubMed

    Zhang, Xin; Ma, Yong; Fu, Xin; Liu, Qiang; Shao, Zhenxing; Dai, Linghui; Pi, Yanbin; Hu, Xiaoqing; Zhang, Jiying; Duan, Xiaoning; Chen, Wenqing; Chen, Ping; Zhou, Chunyan; Ao, Yingfang

    2016-01-01

    Runx2 is a powerful osteo-inductive factor and adipose-derived stem cells (ADSCs) are multipotent. However, it is unknown whether Runx2-overexpressing ADSCs (Runx2-ADSCs) could promote anterior cruciate ligament (ACL) reconstruction. We evaluated the effect of Runx2-ADSCs on ACL reconstruction in vitro and in vivo. mRNA expressions of osteocalcin (OCN), bone sialoprotein (BSP) and collagen I (COLI) increased over time in Runx2-ADSCs. Runx2 overexpression inhibited LPL and PPAR? mRNA expressions. Runx2 induced alkaline phosphatase activity markedly. In nude mice injected with Runx2-ADSCs, promoted bone formation was detected by X-rays 8 weeks after injection. The healing of tendon-to-bone in a rabbit model of ACL reconstruction treated with Runx2-ADSCs, fibrin glue only and an RNAi targeting Runx2, was evaluated with CT 3D reconstruction, histological analysis and biomechanical methods. CT showed a greater degree of new bone formation around the bone tunnel in the group treated with Runx2-ADSCs compared with the fibrin glue group and RNAi Runx2 group. Histology showed that treatment with Runx2-ADSCs led to a rapid and significant increase at the tendon-to-bone compared with the control groups. Biomechanical tests demonstrated higher tendon pullout strength in the Runx2-ADSCs group at early time points. The healing of the attachment in ACL reconstruction was enhanced by Runx2-ADSCs. PMID:26743583

  20. Augmentation of Bone Tunnel Healing in Anterior Cruciate Ligament Grafts: Application of Calcium Phosphates and Other Materials

    PubMed Central

    Baxter, F. R.; Bach, J. S.; Detrez, F.; Cantournet, S.; Corté, L.; Cherkaoui, M.; Ku, D. N.

    2010-01-01

    Bone tunnel healing is an important consideration after anterior cruciate ligament (ACL) replacement surgery. Recently, a variety of materials have been proposed for improving this healing process, including autologous bone tissue, cells, artificial proteins, and calcium salts. Amongst these materials are calcium phosphates (CaPs), which are known for their biocompatibility and are widely commercially available. As with the majority of the materials investigated, CaPs have been shown to advance the healing of bone tunnel tissue in animal studies. Mechanical testing shows fixation strengths to be improved, particularly by the application of CaP-based cement in the bone tunnel. Significantly, CaP-based cements have been shown to produce improvements comparable to those induced by potentially more complex treatments such as biologics (including fibronectin and chitin) and cultured cells. Further investigation of CaP-based treatment in the bone tunnels during ACL replacement is therefore warranted in order to establish what improvements in healing and resulting clinical benefits may be achieved through its application. PMID:21350646

  1. A case of anterior cruciate ligament tear accompanied by avulsion fractures of tibial tuberosity and Gerdy's tubercle.

    PubMed

    Yoo, Jae Ho; Kim, Kang-Il; Yoon, Kyoung Ho

    2011-12-01

    A 54-year-old man visited our clinic due to a painful swelling of his right knee. He had attempted a forceful kick by his right leg during a Sepak Takraw-like sports activity, only to fail to hit the ball. He felt a popping sense on the knee and collapsed, even without direct trauma. Imaging studies revealed a disruption of the anterior cruciate ligament (ACL), and separate avulsion fractures of the tibial tuberosity and Gerdy's tubercle. The fractures were stabilized by two cancellous screws, respectively. The intra-operative fluoroscopy demonstrated a manifest ACL insufficiency. A simultaneous reconstruction of the ligament was not performed. At 6 months after surgery, he had no difficulty in his activities of daily living. The involved knee joint was believed to have undergone a forceful pivot shift mechanism. Injuries to the ACL can be suspected from indirect signs on the radiologic images by a careful reconstitution of the injury mechanism and the associated lesions. Manifest osseous lesions on the plain radiographs can herald a major ligamentous injury and may be interpreted as an indirect sign of the ACL injury, which helps to establish a relevant management plan. PMID:20724164

  2. Hydroxyapatite-doped polycaprolactone nanofiber membrane improves tendon–bone interface healing for anterior cruciate ligament reconstruction

    PubMed Central

    Han, Fei; Zhang, Peng; Sun, Yaying; Lin, Chao; Zhao, Peng; Chen, Jiwu

    2015-01-01

    Hamstring tendon autograft is a routine graft for anterior cruciate ligament (ACL) reconstruction. However, ways of improving the healing between the tendon and bone is often overlooked in clinical practice. This issue can be addressed by using a biomimetic scaffold. Herein, a biomimetic nanofiber membrane of polycaprolactone/nanohydroxyapatite/collagen (PCL/nHAp/Col) is fabricated that mimics the composition of native bone tissue for promoting tendon–bone healing. This membrane has good cytocompatibility, allowing for osteoblast cell adhesion and growth and bone formation. As a result, MC3T3 cells reveal a higher mineralization level in PCL/nHAp/Col membrane compared with PCL membrane alone. Further in vivo studies in ACL reconstruction in a rabbit model shows that PCL/nHAp/Col-wrapped tendon may afford superior tissue integration to nonwrapped tendon in the interface between the tendon and host bone as well as improved mechanical strength. This study shows that PCL/nHAp/Col nanofiber membrane wrapping of autologous tendon is effective for improving tendon healing with host bone in ACL reconstruction. PMID:26677323

  3. Interdisciplinary Management of Deep Vein Thrombosis During Rehabilitation of Acute Rupture of the Anterior Cruciate Ligament: A Case Report

    PubMed Central

    Reckelhoff, Kenneth E.; Miller, Anthony

    2014-01-01

    Objective The purpose of this case report is to describe a patient who experienced deep venous thrombosis (DVT) during pre-operative rehabilitation of an acute rupture of an anterior cruciate ligament (ACL) reconstruction graft, to increase awareness of DVT occurring in a healthy individual after periodic immobilization, and to describe the interdisciplinary management for this patient. Clinical features A 30-year-old male was referred to a chiropractic clinic for presurgical treatment of a left ACL rupture and medial meniscus tear confirmed at magnetic resonance imaging. During the course of preoperative rehabilitation, the patient became limited in ambulation and presented for a routine rehabilitation visit. During this visit, he experienced increased leg swelling, pain and tenderness. The patient was assessed for DVT and was referred to the local emergency department for further evaluation where multiple DVTs were found in the left popliteal, posterior tibial, and peroneal veins. Intervention/outcome The patient was treated with a 17-week course of warfarin during which time the clinical signs and symptoms of DVT resolved. Meanwhile, the patient completed the rehabilitation treatment plan in preparation for ACL reconstruction without further complications. Conclusions This case raises awareness that DVT may occur in a healthy individual after periodic immobilization. While there may be controversy regarding the appropriate application of pharmaceutical anticoagulants in patients with DVT of the leg, the most risk averse strategy is for a short duration prescription medication with compression stockings. Through interdisciplinary management, the patient experienced a successful outcome. PMID:25685121

  4. Posttraumatic knee osteoarthritis following anterior cruciate ligament injury: Potential biochemical mediators of degenerative alteration and specific biochemical markers

    PubMed Central

    LI, HONG; CHEN, CHEN; CHEN, SHIYI

    2015-01-01

    As a common injury, anterior cruciate ligament (ACL) injury is unable to heal itself naturally, which possibly increases knee instability, accelerates the risk of joint degeneration and leads to knee osteoarthritis (OA) in the ACL-injured knee. Thus, ACL reconstruction using an autograft or allograft tendon is proposed to maintain the biomechanical stability of the knee joint. However, previous studies demonstrate that surgical management of ACL reconstruction failed to abrogate the development of OA completely, indicating that biochemical disturbance is responsible for the osteoarthritic changes observed following ACL injury. Inflammatory mediators are elevated subsequent to ACL injury or rupture, inducing matrix metalloproteinase production, proteoglycan degradation, collagen destruction, chondrocyte necrosis and lubricin loss. These potential biochemical mediators may aid in the development of effective biological management to reduce the onset of future posttraumatic OA. Furthermore, during the degenerative process of cartilage, there are a number of cartilage-specific biomarkers, which play a critical step in the loss of structural and functional integrity of cartilage. The present review illustrates several specific biomarkers in the ACL-injured knee joint, which may provide effective diagnostic and prognostic tools for investigating cartilage degenerative progression and future posttraumatic OA of ACL-injured patients. PMID:25798238

  5. Application of genomics in the prevention, treatment and management of Achilles tendinopathy and anterior cruciate ligament ruptures.

    PubMed

    September, A V; Posthumus, M; Collins, M

    2012-12-01

    Musculoskeletal soft tissue injuries such as Achilles tendinopathy and anterior cruciate ligament ruptures are common among elite athletes, recreational athletes and physically active individuals. The consequences of injury may be devastating and prevent the recreational or competitive athlete from reaching their potential or lead to a premature end to their careers. Although these injuries have been well described at a clinical level, the biological mechanisms causing these injuries are poorly understood. A further understanding of the biological mechanisms underlying the injury will assist the treatment and management of these injuries. In addition, understanding the biology is an important prerequisite in developing models that can be used to effectively identify risk, as well as, implement personalized prevention, treatment and rehabilitation programmes. Both intrinsic, including genetic variants, and extrinsic risk factors have nevertheless been implicated in the aetiology of these injuries. To date, several patents have been filed which involve the use of specific polymorphisms and regions within specific genes to be used in a genetic test for either tendon or ligament injury risk. The objective of this manuscript will be to review the evidence for the genetic predisposition to soft tissue injury, as well as the application of this data in the prevention, treatment and management of musculoskeletal soft tissue injuries. PMID:22762739

  6. [Augmented anterior cruciate ligament replacement with the Kennedy-LAD (ligament augmentation device)--long term outcome].

    PubMed

    Riel, K A

    1998-01-01

    The ligament augmentation device (Kennedy-LAD) is used to protect tendon grafts during the posttransplantation decrease in strength in anterior cruciate ligament (acl) reconstructions. The augmentation with the LAD is based on the concept of load sharing. Since 1983 we used the LAD in acl-reconstructions in 856 patients. In 63 cases we had to treat complications like infection (8), recurrent effusions (21), arthrofibrosis (34). The overall results are good with respect to stability, regain of strength and sports activity. In 73 cases resurgery was necessary because of synovitis (7), LAD-rupture due to re-injury (9), fatigue-rupture of the LAD (22), meniscal tears (35), 2.7 +/- 2.3 years (range: 2 months to 10 years) after LAD implantation. Modern techniques in acl reconstruction lead to comparable results without synthetic augmentation. Therefore, we now recommend the use of a LAD only in cases of repeated acl replacement with week tendon grafts, to avoid an allograft. PMID:9816660

  7. Assessment of functional impairment after knee anterior cruciate ligament reconstruction using cardiorespiratory parameters: a cross-sectional study

    PubMed Central

    2014-01-01

    Background A dynamic sub-maximum exercise with the same absolute intensity, performed with different muscle groups, may present exacerbated cardiorespiratory responses. Therefore, cardiorespiratory responses to unilateral exercise may identify bilateral differences. The purpose of this study was to verify whether the cardiorespiratory responses to lower limb exercise display counter-lateral differences, and if they could be used to assist athletes and health professionals involved in rehabilitation. Methods Nine individuals participated in this cross-sectional study. They had been treated in a private rehabilitation clinic and submitted to intra-articular reconstruction of the anterior cruciate ligament. The cycling exercise with the same sub-maximal intensity and with one lower limb was used to gather data. Cardiorespiratory responses to exercise were compared between exercises performed with the involved and uninvolved limb after five minutes of exercise. Results Cardiorespiratory responses to exercise performed with the involved limb presented higher values after five minutes of cycling: oxygen uptake (+7%), carbon dioxide production (+10%), minute ventilation (+20%), breathing frequency (+19%), ventilatory equivalent for oxygen (+14%), end-tidal pressure of O2 oxygen (+4%), end-tidal pressure of O2 carbon dioxide (-9%) and heart rate (+9%). Conclusions The exacerbated responses, including increase of the ventilatory equivalent and decrease of end-tidal pressure of carbon dioxide, indicate that this exercise protocol may be useful in the characterization of the functional deficit of the surgical limb during rehabilitation. PMID:24885115

  8. Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching

    NASA Astrophysics Data System (ADS)

    Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

    2014-09-01

    This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

  9. Neuromuscular efficiency of the vastus lateralis and biceps femoris muscles in individuals with anterior cruciate ligament injuries?

    PubMed Central

    Aragão, Fernando Amâncio; Schäfer, Gabriel Santo; de Albuquerque, Carlos Eduardo; Vituri, Rogério Fonseca; de Azevedo, Fábio Mícolis; Bertolini, Gladson Ricardo Flor

    2015-01-01

    Objective To analyze strength and integrated electromyography (IEMG) data in order to determine the neuromuscular efficiency (NME) of the vastus lateralis (VL) and biceps femoris (BF) muscles in patients with anterior cruciate ligament (ACL) injuries, during the preoperative and postoperative periods; and to compare the injured limb at these two times, using the non-operated limb as a control. Methods EMG data and BF and VL strength data were collected during three maximum isometric contractions in knee flexion and extension movements. The assessment protocol was applied before the operation and two months after the operation, and the NME of the BF and VL muscles was obtained. Results There was no difference in the NME of the VL muscle from before to after the operation. On the other hand, the NME of the BF in the non-operated limb was found to have increased, two months after the surgery. Conclusions The NME provides a good estimate of muscle function because it is directly related to muscle strength and capacity for activation. However, the results indicated that two months after the ACL reconstruction procedure, at the time when loading in the open kinetic chain within rehabilitation protocols is usually started, the neuromuscular efficiency of the VL and BF had still not been reestablished. PMID:26229914

  10. Acute fatigue impairs neuromuscular activity of anterior cruciate ligament-agonist muscles in female team handball players.

    PubMed

    Zebis, M K; Bencke, J; Andersen, L L; Alkjaer, T; Suetta, C; Mortensen, P; Kjaer, M; Aagaard, P

    2011-12-01

    In sports, like team handball, fatigue has been associated with an increased risk of anterior cruciate ligament (ACL) injury. While effects of fatigue on muscle function are commonly assessed during maximal isometric voluntary contraction (MVC), such measurements may not relate to the muscle function during match play. The purpose of this study was to investigate the effect of muscle fatigue induced by a simulated handball match on neuromuscular strategy during a functional sidecutting movement, associated with the incidence of ACL injury. Fourteen female team handball players were tested for neuromuscular activity [electromyography (EMG)] during a sidecutting maneuver on a force plate, pre and post a simulated handball match. MVC was obtained during maximal isometric quadriceps and hamstring contraction. The simulated handball match consisted of exercises mimicking handball match activity. Whereas the simulated handball match induced a decrease in MVC strength for both the quadriceps and hamstring muscles (P<0.05), a selective decrease in hamstring neuromuscular activity was seen during sidecutting (P<0.05). This study shows impaired ACL-agonist muscle (i.e. hamstring) activity during sidecutting in response to acute fatigue induced by handball match play. Thus, screening procedures should involve functional movements to reveal specific fatigue-induced deficits in ACL-agonist muscle activation during high-risk phases of match play. PMID:20500560

  11. Chiropractic management of a postoperative complete anterior cruciate ligament rupture using a multimodal approach: a case report

    PubMed Central

    Solecki, Thomas J.; Herbst, Elizabeth M.

    2011-01-01

    Objective The purpose of this case report is to describe the chiropractic management of a patient who had postoperative reconstructive surgery for an anterior cruciate ligament (ACL) tear. Clinical Features A 25-year-old man experienced a rupture of his left ACL, as well as a bucket-handle tear of the medial meniscus and full-thickness tear within the posterior horn of the lateral meniscus, following direct-contact trauma while playing basketball. Intervention and Outcome Postoperative care included a 12-week functional chiropractic rehabilitation program along with Active Release Technique, Graston Technique, and Kinesio Taping. Following treatment, the patient recorded a 0/10 on the Numeric Pain Scale, recorded improvement on the Patient Specific Functional and Pain Scales, returned to play with no complications, and had complete restoration of range of motion and lower extremity muscle strength. At 1-year follow-up, the patient reported no pain and was fully functional. Conclusion A multimodal approach to the treatment of a postsurgical ACL repair was successful in restoring functional ability, as well as complete subjective pain relief. Chiropractic care may be a beneficial addition to the care of postoperative patients. PMID:22027208

  12. Biomechanical and neuromuscular characteristics of male athletes: implications for the development of anterior cruciate ligament injury prevention programs.

    PubMed

    Sugimoto, Dai; Alentorn-Geli, Eduard; Mendiguchía, Jurdan; Samuelsson, Kristian; Karlsson, Jon; Myer, Gregory D

    2015-06-01

    Prevention of anterior cruciate ligament (ACL) injury is likely the most effective strategy to reduce undesired health consequences including reconstruction surgery, long-term rehabilitation, and pre-mature osteoarthritis occurrence. A thorough understanding of mechanisms and risk factors of ACL injury is crucial to develop effective prevention programs, especially for biomechanical and neuromuscular modifiable risk factors. Historically, the available evidence regarding ACL risk factors has mainly involved female athletes or has compared male and female athletes without an intra-group comparison for male athletes. Therefore, the principal purpose of this article was to review existing evidence regarding the investigation of biomechanical and neuromuscular characteristics that may imply aberrant knee kinematics and kinetics that would place the male athlete at risk of ACL injury. Biomechanical evidence related to knee kinematics and kinetics was reviewed by different planes (sagittal and frontal/coronal), tasks (single-leg landing and cutting), situation (anticipated and unanticipated), foot positioning, playing surface, and fatigued status. Neuromuscular evidence potentially related to ACL injury was reviewed. Recommendations for prevention programs for ACL injuries in male athletes were developed based on the synthesis of the biomechanical and neuromuscular characteristics. The recommendations suggest performing exercises with multi-plane biomechanical components including single-leg maneuvers in dynamic movements, reaction to and decision making in unexpected situations, appropriate foot positioning, and consideration of playing surface condition, as well as enhancing neuromuscular aspects such as fatigue, proprioception, muscle activation, and inter-joint coordination. PMID:25663251

  13. Anterior Cruciate Ligament Reconstruction in a Rabbit Model Using Silk-Collagen Scaffold and Comparison with Autograft

    PubMed Central

    Bi, Fanggang; Shi, Zhongli; Liu, An; Guo, Peng; Yan, Shigui

    2015-01-01

    The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL) reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application. PMID:25938408

  14. The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ko, Young Won; Rhee, Seung Jun; Kim, In Woo

    2015-01-01

    Purpose Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a frequently described phenomenon. The possible etiology is multi-factorial with some mechanical and biological factors. Among those, we intended to determine the relation between the location and orientation of the femoral tunnel and the femoral tunnel enlargement after outside-in single-bundle ACL reconstruction. Materials and Methods A retrospective study including 42 patients who received single-bundle ACL reconstruction with the outside-in technique was conducted. Femoral and tibial tunnel locations were evaluated with the quadrant method and bird's-eye view using volume-rendering computed tomography. The angle and diameter of bone tunnel and the degree of tunnel enlargement were evaluated using standard radiographs. Results The degree of femoral tunnel enlargements were 42% and 36% on the anteroposterior (AP) and lateral radiographs, respectively, and the degree of tibial tunnel enlargements were 22% and 23%, respectively. Shallower location of the femoral tunnel was significantly correlated with greater femoral tunnel enlargement on the AP radiograph (r=0.998, p=0.004) and the lateral radiograph (r=0.72, p=0.005) as was the higher location of the femoral tunnel on the AP radiograph (r=-0.47, p=0.01) and the lateral radiograph (r=-0.36, p=0.009) at 12 months after surgery. Conclusions This study revealed that more anterior and higher location and more horizontal orientation of the femoral tunnel in coronal plane could result in widening of the femoral tunnel in outside-in single-bundle ACL reconstruction. PMID:26672479

  15. Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up

    PubMed Central

    Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schüttler, Karl Friedrich; Ziring, Ewgeni

    2012-01-01

    The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1–T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25–100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis. PMID:22802989

  16. Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up.

    PubMed

    Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schüttler, Karl Friedrich; Ziring, Ewgeni

    2012-05-01

    The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25-100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis. PMID:22802989

  17. Overrepresentation of the COL3A1 AA genotype in Polish skiers with anterior cruciate ligament injury

    PubMed Central

    Ficek, K; Maciejewska-Kar?owska, A; Sawczuk, M; Zi?tek, P; Król, P; Zmijewski, P; Pokrywka, A; Ci?szczyk, P

    2015-01-01

    Although various intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) rupture have been identified, the exact aetiology of the injury is not yet fully understood. Type III collagen is an important factor in the repair of connective tissue, and certain gene polymorphisms may impair the tensile strength. The aim of this study was to examine the association of the COL3A1 rs1800255 polymorphism with ACL rupture in Polish male recreational skiers. A total of 321 male Polish recreational skiers were recruited for this study; 138 had surgically diagnosed primary ACL ruptures (ACL-injured group) and 183 were apparently healthy male skiers (control group – CON) who had no self-reported history of ligament or tendon injury. Both groups had a comparable level of exposure to ACL injury. Genomic DNA was extracted from the oral epithelial cells. All samples were genotyped on a real-time polymerase chain reaction instrument. The genotype distribution in the ACL-injured group was significantly different than in CON (respectively: AA=10.1 vs 2.2%, AG=22.5 vs 36.1, GG=67.4 vs 61.8%; p=0.0087). The AA vs AG+GG genotype of COL3A1 (odds ratio (OR)=5.05; 95% confidence interval (CI), 1.62-15.71, p=0.003) was significantly overrepresented in the ACL-injured group compared with CON. The frequency of the A allele was higher in the ACL-injured group (21.4%) compared with CON (20.2%), but the difference was not statistically significant (p=0.72). This study revealed an association between the COL3A1 rs1800255 polymorphism and ACL ruptures in Polish skiers. PMID:26060338

  18. Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brophy, Robert H.; Wright, Rick W.; David, Tal S.; McCormack, Robert G.; Sekiya, Jon K.; Svoboda, Steven J.; Huston, Laura J.; Haas, Amanda K.; Steger-May, Karen

    2013-01-01

    Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ? .03). Conclusion The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may reflect underlying differences in the knee at the time of prior surgery, it does suggest that meniscal repair is preferable when possible at the time of ACL reconstruction. PMID:22374942

  19. Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors.

    PubMed

    Matava, M J; Evans, T A; Wright, R W; Shively, R A

    1998-10-01

    To determine the incidence of joint sepsis following anterior cruciate ligament (ACL) reconstruction and the prevailing attitudes toward its treatment, we surveyed the directors of Sports Medicine Fellowship programs about their practices in treating and preventing this complication. Of the 74 surgeons surveyed, 61 (82%) responded. These 61 surgeons performed an average of 98 ACL reconstructions yearly; 31 (51 %) routinely used a drain after ACL surgery, 18 (30%) had treated an ACL infection within the past 2 years, and 26 (43%) had treated an infection within the past 5 years. There was no significant difference in the number of infections and the surgeons' case load, graft choice, or method of reconstruction. Fifty-two surgeons (85%) selected culture-specific intravenous (IV) antibiotics and surgical irrigation of the joint with graft retention as initial treatment for the infected patellar tendon autograft, and 39 (64%) chose this regimen to treat the infected allograft. For the resistant infection unresponsive to initial treatment, IV antibiotics with surgical irrigation and graft retention were also selected as the most common treatment combination for 25 (39%) of the 61 respondents. After graft removal, the earliest a revision procedure would be considered was 6 to 9 months. The results of this survey confirm the widely held belief that septic arthritis of the knee is a relatively rare complication following ACL reconstruction. Once an infection is encountered, culture-specific IV antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft excision and hardware removal is considered only for those infections resistant to initial treatment and for the infected allograft. PMID:9788367

  20. Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction

    NASA Astrophysics Data System (ADS)

    Yao, Jie; Kuang, Guan-Ming; Wong, Duo Wai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

    2014-04-01

    Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy den sity (SED) distribution after the anatomic single-bundle ACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9 mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw. [Figure not available: see fulltext.

  1. Evaluation of effectiveness of kinesiology taping as an adjunct to rehabilitation following anterior cruciate ligament reconstruction. Preliminary report.

    PubMed

    Boguszewski, Dariusz; Tomaszewska, Iwona; Adamczyk, Jakub Grzegorz; Bia?oszewski, Dariusz

    2013-10-31

    BACKGROUND. Kinesiology Taping (KT) is being increasingly more often used in musculoskeletal rehabilitation. The aim of the study was to assess the effect of Kinesiology Taping on rehabilitation outcomes in patients following anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS. The study enrolled 26 patients (16 women and 10 men) aged between 20 and 41 years. The patients were randomly divided into two groups: an experimental group (Group 1), which received Kinesiology Taping, and a control group (Group 2), which followed the same rehabilitation protocol except for KT. Student's t test with a minimum significance level at p<0.05 was used for statistical analysis. RESULTS. All participants demonstrated a significant improvement in the range of knee flexion and extension in the affected limb as soon as the end of the first week of rehabilitation (p?0.001). This tendency persisted in the following weeks until Day 28. Thigh measurements revealed a faster increase in thigh circumference in Group 1. Significant swelling reduction was found among patients from the experimental group at all consecutive measurements. The greatest difference (p<0.001) was noted at the beginning of the rehabilitation. After 28 days of rehabilitation, pain intensity and pain frequency had significantly decreased in all patients (p<0.001). Patients from the control group used analgesics significantly more often. CONCLUSIONS. 1. The use of KT contributed to a faster improvement of the range of knee motion, reduction of oedema and greater improvement in thigh circumference. 2. A similar reduction in pain intensity was observed in all patients. However, pain significantly less often forced patients from the experimental group to use analgesics or reduced their activity. PMID:24431257

  2. Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: recent evidence and a personal reflection.

    PubMed

    Renström, Per A

    2013-04-01

    Over two million anterior cruciate ligament (ACL) injuries occur worldwide annually, and the greater prevalence for ACL injury in young female athletes is one of the major problems in sports medicine. Optimal treatment of ACL injury requires individualised management. Patient selection is of utmost importance, and so is respect for the patient's functional demands and interests. All patients with an ACL tear may not need surgery, however athletes and persons with an active lifestyle with high knee functional demands including cutting motions need and should be offered surgery. In many cases it may not be the choice of graft or technique that is the key for success, but the choice of surgeon. The surgeon should be experienced and use a reconstructive procedure he/she knows very well and is comfortable with. The development of osteoarthritis after an ACL injury depends very much on the injury mechanism and concurrent meniscal injury, as knee articular cartilage continues to heal for 1-2 years after an ACL injury. Therefore the surgeon and rehabilitation team must pay attention to the rehabilitation process and to the decision when to return to sport. Return to sport must be carefully considered, as top-level sport in itself is one main risk factor for osteoarthritis after ACL injury. The present criteria for return to sport need to be revisited, also due to the fact that recurrent injury seems to be an increasing problem. ACL injury prevention programmes are now available in some sports. The key issue for a prevention programme to be successful is proper implementation. Vital factors for success include the individual coaching of the player and well controlled compliance with the training programme. Preventive activities should be more actively supported by the involved athletic community. Despite substantial advances in the field of ACL injury over the past 40 years, substantial management challenges remain. PMID:22942168

  3. Comparison of femoral fixation methods for anterior cruciate ligament reconstruction with patellar tendon graft: a mechanical analysis in porcine knees.

    PubMed

    Milano, Giuseppe; Mulas, Pier Damiano; Ziranu, Fabio; Deriu, Laura; Fabbriciani, Carlo

    2007-06-01

    The aim of the present study was to evaluate the structural properties of femur-patellar tendon graft complex in anterior cruciate ligament (ACL) reconstruction using different femoral fixation devices. Type of study is biomechanical testing. An ACL reconstruction was performed on 40 cadaver porcine knees, using patellar tendon (PT) graft. Specimens were divided into four groups according to the femoral fixation: interference absorbable screw (Group A), metallic setscrew (Group B), absorbable pins (Group C), and a combination of metallic setscrew and pin (Group D). Other ten knees were used as controls. On each sample, a cyclic loading test, then a load-to-failure test were performed. Elongation after 1,000 loading cycles, ultimate failure load, yield load, stiffness, deformation at the yield point, and mode of failure were recorded. Kruskal-Wallis test and Tukey test were used to compare the differences between groups. The lowest mean elongation after 1,000 load cycles was observed for Group B (1.7 +/- 1.4 mm) and D (1.2 +/- 0.3 mm). Ultimate failure load of Group D (1,021.8 +/- 199.4 N) was comparable with that of normal ACL (1,091.2 +/- 193.3 N) and PT graft (1,140.6 +/- 285.7 N). All other groups were lower than the controls. For mean stiffness, all the groups, excepting for Group D (172.8 +/- 40.4 N/mm), were significantly lower than PT control group (216 +/- 78.4 N/mm). Mode of failure was graft pullout for Groups A and B, distal pin breakage for Group C, and midsubstance graft rupture in 80% of the cases for Group D. Only combined compression and suspension fixation did not show significantly different structural properties in comparison with normal ACL and PT graft. Furthermore, it showed no risk of graft pullout or hardware breakdown in comparison with other fixation devices. PMID:17295042

  4. Change in T2* relaxation time of Hoffa fat pad correlates with histologic change in a rat anterior cruciate ligament transection model.

    PubMed

    Wang, Chao-Ying; Tsai, Ping-Huei; Siow, Tiing Yee; Lee, Herng-Sheng; Chang, Yue-Cune; Hsu, Yi-Chih; Chiang, Shih-Wei; Lin, Ming-Huang; Chung, Hsiao-Wen; Huang, Guo-Shu

    2015-09-01

    The Hoffa fat pad (infrapatellar fat pad) is a source of post-traumatic anterior knee pain, and Hoffa disease is a syndrome leading to chronic inflammation of the fat pad. Herein, change in T2* relaxation time of the fat pad was measured in a rodent anterior cruciate ligament transection (ACLX) model in order to (i) examine the causal relationship of anterior cruciate ligament (ACL) deficiency and Hoffa disease and (ii) demonstrate the feasibility of using T2* as an imaging biomarker to monitor disease progression. Three groups of male Sprague Dawley rats (n?=?6 each group), received either (i) no intervention; (ii) sham surgery at the right knee; or (iii) right ACLX. T2* relaxation time was measured and histology was examined in the Hoffa fat pad after surgery. At 13 and 18 weeks after surgery, T2* values were significantly higher in the right fat pad than the left (p?

  5. The Variants Within the COL5A1 Gene are Associated with Reduced Risk of Anterior Cruciate Ligament Injury in Skiers.

    PubMed

    St?pie?-S?odkowska, Marta; Ficek, Krzysztof; Kaczmarczyk, Mariusz; Maciejewska-Kar?owska, Agnieszka; Sawczuk, Marek; Leo?ska-Duniec, Agata; St?pi?ski, Mi?osz; Zi?tek, Pawe?; Król, Pawe?; Chudecka, Monika; Ci?szczyk, Pawe?

    2015-03-29

    The purpose of this study was to examine the association of the BstUI RFLP C/T (rs 12722) and DpnII RFLP C/T (rs 13946) COL5A1 polymorphisms, individually and as haplotypes, with anterior cruciate ligament ruptures in recreational skiers. Subjects were 138 male recreational skiers with surgically diagnosed primary anterior cruciate ligament ruptures. The control group consisted of 183 apparently healthy male recreational skiers, who were without any self-reported history of ligament or tendon injury. DNA was extracted from buccal cells donated by the subjects and genotyping was carried out using real-time PCR. The genotype distributions for both polymorphisms met Hardy-Weinberg expectations in both groups. There were no significant differences in genotype distribution of allele frequencies of COL5A1 BstUI RFLP C/T and COL5A1 DpnII RFLP C/T polymorphisms between the ACL rupture and control groups. The T-T (BstUI RFLP T, DpnII RFLP T) haplotype was the most common (55.6%). The haplotype T-C was not present in any of the subjects. There was an underrepresentation tendency of the C-T haplotype in the study group compared to controls under recessive mode of inheritance. Higher frequency of the COL5A1 BstUI RFLP C/T and COL5A1DpnII RFLP C/T polymorphisms haplotype is associated with reduced risk of anterior cruciate ligament injury in a group of apparently healthy male recreational skiers. PMID:25964814

  6. Neuromuscular Fatigue Alters Postural Control and Sagittal Plane Hip Biomechanics in Active Females With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Frank, Barnett S.; Gilsdorf, Christine M.; Goerger, Benjamin M.; Prentice, William E.; Padua, Darin A.

    2014-01-01

    Background: Females with history of anterior cruciate ligament (ACL) injury and subsequent ligament reconstruction are at high risk for future ACL injury. Fatigue may influence the increased risk of future injury in females by altering lower extremity biomechanics and postural control. Hypothesis: Fatigue will promote lower extremity biomechanics and postural control deficits associated with ACL injury. Study Design: Descriptive laboratory study. Methods: Fourteen physically active females with ACL reconstruction (mean age, 19.64 ± 1.5 years; mean height, 163.52 ± 6.18 cm; mean mass, 62.6 ± 13.97 kg) volunteered for this study. Postural control and lower extremity biomechanics were assessed in the surgical limb during single-leg balance and jump-landing tasks before and after a fatigue protocol. Main outcome measures were 3-dimensional hip and knee joint angles at initial contact, peak angles, joint angular displacements and peak net joint moments, anterior tibial shear force, and vertical ground reaction force during the first 50% of the loading phase of the jump-landing task. During the single-leg stance task, the main outcome measure was center of pressure sway speed. Results: Initial contact hip flexion angle decreased (t = ?2.82, P = 0.01; prefatigue, 40.98° ± 9.79°; postfatigue, 36.75° ± 8.61°) from pre- to postfatigue. Hip flexion displacement (t = 2.23, P = 0.04; prefatigue, 45.19° ± 14.1°; postfatigue, 47.48° ± 14.21°) and center of pressure sway speed (t = 3.95, P < 0.05; prefatigue, 5.18 ± 0.96 cm/s; postfatigue, 6.20 ± 1.72 cm/s) increased from pre- to postfatigue. There was a trending increase in hip flexion moment (t = 2.14, P = 0.05; prefatigue, 1.66 ± 0.68 Nm/kg/m; postfatigue, 1.91 ± 0.62 Nm/kg/m) from pre- to postfatigue. Conclusion: Fatigue may induce lower extremity biomechanics and postural control deficits that may be associated with ACL injury in physically active females with ACL reconstruction. Clinical Relevance: Rehabilitation and maintenance programs should incorporate activities that aim to improve muscular endurance and improve the neuromuscular system’s tolerance to fatiguing exercise in efforts to maintain stability and safe landing technique during subsequent physical activity. PMID:24982701

  7. Displaced osteochondral fracture of the lateral femoral condyle associated with an acute anterior cruciate ligament avulsion fracture: a corollary of "the lateral femoral notch sign".

    PubMed

    Sharma, Gaurav; Naik, V Anand; Pankaj, Amite

    2012-08-01

    Anterior cruciate ligament (ACL) rupture is usually accompanied by bone contusions resulting from impact of tibia on femur. The injury sometimes becomes manifest as a depression on the lateral femoral condyle giving rise to "lateral femoral notch" sign. The authors describe a rare case of impaction of the tibia and femur resulting in an osteochondral fracture rather than the usual bone contusion, which frequently occurs with ACL rupture. Open reduction and internal fixation of both the ACL avulsion fracture and the osteochondral fracture from the lateral femoral condyle were done, and the patient had a good outcome at 1-year follow-up. Level of evidence V. PMID:22113226

  8. [Troublesome radiologic changes after reconstructive fixation of the anterior cruciate ligament with resorbable interference screws].

    PubMed

    Loubignac, F; Lecuire, F; Rubini, J; Basso, M

    1998-03-01

    The authors report worrisome radiological changes which were noted after implantation of absorbable interference screws in ligamentoplasty at the knee joint. Seventeen screws were implanted between September 1995 and July 1996, in eleven patients (average age 27) who were operated upon for chronic anterior knee instability. They underwent a modified Kenneth Jones procedure using autografts with absorbable interference screws (Acufex in 2 cases and Bio-interférix in 9 cases). Significant enlargement of bone tunnels and bony sclerosis of their edges were noted in every patient, but without any modification in the positioning of the graft. No clinical instability was observed in any of the patients, with one to two years follow-up. Publications on this topic are scarce except for one author who reported enlargement of bone tunnels after using bone-patellar tendon-bone allografts. Resorption of absorbable screws probably induces a marked inflammatory reaction, with radiological changes reminiscent of those sometimes observed after tendon allografts. Although the radiological changes reported here may not affect the graft fixation, the authors have reverted to using metallic interference screws. PMID:9586250

  9. Two Cases of Contact Anterior Cruciate Ligament Rupture Combined with a Posterolateral Tibial Plateau Fracture

    PubMed Central

    Jiang, Liangjun; Wu, Haobo; Yan, Shigui

    2015-01-01

    Background. The combined occurrence of ACL rupture with a posterolateral tibial plateau fracture has not yet been reported. Two cases of such injuries have been treated in our department for the past three years. Findings. The two patients both suffered injuries from traffic accidents. The radiological examinations showed a ruptured ACL with fracture of the posterolateral tibial plateau. Reconstruction of the ACL was performed via a standard anatomical single bundle ACL reconstruction technique with autologous tendon by arthroscopy. A posterolateral tibia plateau approach was used to reduce and fix the fractured area with the aid of lag screws. After a one-year follow-up, the two patients recovered well and physical examinations showed full knee range of motion with no evidence of ACL instability. Conclusions. The cause of this type injury of ACL rupture with a posterolateral tibial plateau fracture was thought to be by a violent internal tibial rotation/anterior tibial translation without any valgus or varus knee force mechanism during the accident. Satisfactory clinical results were achieved with a standard anatomical single bundle ACL reconstruction by arthroscopy and ORIF for the posterolateral plateau fracture. Both patients reported excellent knee function and fracture healing. PMID:26236518

  10. The effects of isometric and isotonic training on hamstring stiffness and anterior cruciate ligament loading mechanisms.

    PubMed

    Blackburn, J Troy; Norcross, Marc F

    2014-02-01

    Greater hamstring musculotendinous stiffness is associated with lesser ACL loading mechanisms. Stiffness is enhanced via training, but previous investigations evaluated tendon rather than musculotendinous stiffness, and none involved the hamstrings. We evaluated the effects of isometric and isotonic training on hamstring stiffness and ACL loading mechanisms. Thirty-six healthy volunteers were randomly assigned to isometric, isotonic, and control groups. Isometric and isotonic groups completed 6 weeks of training designed to enhance hamstring stiffness. Stiffness, anterior tibial translation, and landing biomechanics were measured prior to and following the interventions. Hamstring stiffness increased significantly with isometric training (15.7%; p=0.006), but not in the isotonic (13.5%; p=0.089) or control (0.4%; p=0.942) groups. ACL loading mechanisms changed in manners consistent with lesser loading, but these changes were not statistically significant. These findings suggest that isometric training may be an important addition to ACL injury prevention programs. The lack of significant changes in ACL loading mechanisms and effects of isotonic training were likely due to the small sample sizes per group and limited intervention duration. Future research using larger sample sizes and longer interventions is necessary to determine the effects of enhancing hamstring stiffness on ACL loading and injury risk. PMID:24268874

  11. Effect of Time after Anterior Cruciate Ligament Tears on Proprioception and Postural Stability

    PubMed Central

    Lee, Dae-Hee; Lee, Jin-Hyuck; Ahn, Sung-Eun; Park, Min-Ji

    2015-01-01

    This study was designed to compare proprioception and postural stability in patients with acute (time from injury ? 3 months) and chronic (time from injury > 3 months) ACL tears, and to evaluate the correlation between time interval after ACL injury and proprioception. Thigh muscle strength, postural stability, and joint position sense were compared in 48 patients with acute ACL tears and in 28 with chronic ACL tears. Maximal torque (60°/sec) of the quadriceps and hamstring was evaluated using an isokinetic testing device. Postural stability was determined from the anterior-posterior (APSI), medial-lateral (MLSI), and overall (OSI) stability indices using stabilometry. Joint position sense was also tested by reproduction of passive positioning (RPP). Muscle strengths and stability indices on both the involved and uninvolved sides were similar in the acute and chronic ACL tear groups. RPP on the involved side was significantly greater in the chronic than in the acute ACL tear group (7.8° vs. 5.6°, P = 0.041). Two of three stability indices (APSI, OSI) and RPP were significantly greater on the involved than the uninvolved side in the chronic ACL tear group. PMID:26422800

  12. Rates and Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 College Football Athletes

    PubMed Central

    Daruwalla, Jimmy H.; Greis, Patrick E.; Hancock, Robert; Xerogeanes, John W.

    2014-01-01

    Background: For competitive athletes, return to play (RTP) and return to preinjury levels of performance after anterior cruciate ligament (ACL) reconstruction are the main goals of surgery. Although outcomes of ACL surgery are well studied, details on factors influencing RTP in elite college football players have not been evaluated thoroughly. Purpose: To determine the rate of RTP following ACL surgery among National Collegiate Athletic Association (NCAA) Division 1 collegiate football athletes and to examine variables that may affect these rates. The hypothesis was that the RTP rate in this cohort will be influenced by factors reflecting skill and accomplishment; that is, athletes higher on the depth chart, those on scholarship, and those later in their careers will have higher RTP rates. It was also predicted that graft type and concomitant procedures may have an effect on RTP rates. Study Design: Case series; Level of evidence, 4. Methods: Using athlete- and surgery-specific data from participating institutions in 3 major Division 1 college football conferences, information on athletes who had ACL reconstruction from 2004 through 2010 was collected. Statistical analyses were performed to determine the RTP rate as a function of the variables, such as depth chart position, in the data collected. Results: Of the 184-player cohort, 82% of the athletes, including 94% of starters, were able to RTP. Rates were greater among athletes higher on the depth chart (P = .004) and on scholarship (P = .008). Year of eligibility also affected RTP rates (P = .047), which increased from the redshirt and freshman year to the sophomore and junior years, but then decreased slightly into the senior and fifth-year senior seasons. The use of an autograft versus allograft was associated with increased RTP (P = .045). There was no significant difference (P = .18) between players who underwent an isolated ACL reconstruction versus those who underwent additional procedures. Conclusion: More than 80% of football players at the Division 1 level were able to RTP following ACL reconstruction. Factors representative of a player’s skill were associated with higher rates of RTP. Surgery-specific variables, in general, had no effect on RTP, except for the use of autograft, which was associated with a greater RTP rate. PMID:26535351

  13. Risk of Anterior Cruciate Ligament Fatigue Failure Is Increased by Limited Internal Femoral Rotation During In Vitro Repeated Pivot Landings

    PubMed Central

    Beaulieu, Mélanie L.; Wojtys, Edward M.; Ashton-Miller, James A.

    2015-01-01

    Background A reduced range of hip internal rotation is associated with increased peak anterior cruciate ligament (ACL) strain and risk for injury. It is unknown, however, whether limiting the available range of internal femoral rotation increases the susceptibility of the ACL to fatigue failure. Hypothesis Risk of ACL failure is significantly greater in female knee specimens with a limited range of internal femoral rotation, smaller femoral-ACL attachment angle, and smaller tibial eminence volume during repeated in vitro simulated single-leg pivot landings. Study Design Controlled laboratory study. Methods A custom-built testing apparatus was used to simulate repeated single-leg pivot landings with a 4×-body weight impulsive load that induces knee compression, knee flexion, and internal tibial torque in 32 paired human knee specimens from 8 male and 8 female donors. These test loads were applied to each pair of specimens, in one knee with limited internal femoral rotation and in the contralateral knee with femoral rotation resisted by 2 springs to simulate the active hip rotator muscles’ resistance to stretch. The landings were repeated until ACL failure occurred or until a minimum of 100 trials were executed. The angle at which the ACL originates from the femur and the tibial eminence volume were measured on magnetic resonance images. Results The final Cox regression model (P = .024) revealed that range of internal femoral rotation and sex of donor were significant factors in determining risk of ACL fatigue failure. The specimens with limited range of internal femoral rotation had a failure risk 17.1 times higher than did the specimens with free rotation (P = .016). The female knee specimens had a risk of ACL failure 26.9 times higher than the male specimens (P = .055). Conclusion Limiting the range of internal femoral rotation during repetitive pivot landings increases the risk of an ACL fatigue failure in comparison with free rotation in a cadaveric model. Clinical Relevance Screening for restricted internal rotation at the hip in ACL injury prevention programs as well as in individuals with ACL injuries and/or reconstructions is warranted. PMID:26122384

  14. Tunnel Enlargement and Coalition After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts

    PubMed Central

    Kawaguchi, Yasuyuki; Kondo, Eiji; Onodera, Jun; Kitamura, Nobuto; Sasaki, Tsukasa; Yagi, Tomonori; Yasuda, Kazunori

    2013-01-01

    Background: Tunnel enlargement and coalition following double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts has not yet been sufficiently studied. Hypothesis: The incidence and the degree of femoral tunnel enlargement will be significantly greater than those for tibial tunnel enlargement after anatomic double-bundle ACL reconstruction using hamstring tendon autografts. There will be no significant correlation between tunnel enlargement and coalition and the postoperative knee laxity. Study Design: Case series; Level of evidence, 4. Methods: Thirty-nine patients who underwent anatomic double-bundle ACL reconstruction using semitendinosus and gracilis tendon autografts were followed up for 1 year after surgery. The grafts were simultaneously fixed at 10° of knee flexion with EndoButtons and spiked staples. All patients were examined with computed tomography and the standard clinical evaluation methods at 2 weeks and 1 year after surgery. Results: The degree of tunnel enlargement of the femoral anteromedial and posterolateral tunnels averaged 10% to 11% and 7% to 9%, respectively, while that of the tibial anteromedial and posterolateral tunnels averaged 3% to 7% and 1% to 6%. The degree and incidence of the anteromedial and posterolateral tunnel enlargement were significantly greater in the femur than in the tibia (P < .0335 and P < .0405, respectively). On the femoral and tibial intra-articular surface, tunnel outlet coalition was found in 5% and 77% of the knees, respectively, at 1 year after surgery. There was no significant correlation between tunnel enlargement and coalition and the clinical outcome. Conclusion: The incidence and the degree of each tunnel enlargement in the femur were significantly greater than that in the tibia. However, the incidence of tunnel coalition in the femur was significantly less than that in the tibia after double-bundle ACL reconstruction with a transtibial technique. There was no significant correlation between tunnel enlargement and coalition and the clinical outcome. Clinical Relevance: The present study provides orthopaedic surgeons with important information on double-bundle ACL reconstruction with hamstring tendons. PMID:26535227

  15. Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Packer, Jonathan D.; Bedi, Asheesh; Fox, Alice J.; Gasinu, Selom; Imhauser, Carl W.; Stasiak, Mark; Deng, Xiang-Hua; Rodeo, Scott A.

    2014-01-01

    Background: We previously demonstrated, in a rat anterior cruciate ligament (ACL) graft reconstruction model, that the delayed application of low-magnitude-strain loading resulted in improved tendon-to-bone healing compared with that observed after immediate loading and after prolonged immobilization. The purpose of this study was to determine the effect of higher levels of strain loading on tendon-to-bone healing. Methods: ACL reconstruction was carried out in a rat model in three randomly assigned groups: high-strain daily loading beginning on either (1) postoperative day one (immediate-loading group; n = 7) or (2) postoperative day four (delayed-loading group; n = 11) or (3) after prolonged immobilization (immobilized group; n = 8). Animals were killed two weeks after surgery and micro-computed tomography (micro-CT) and biomechanical testing of the bone-tendon-bone complex were carried out. Results: The delayed-loading group had greater tissue mineral density than either the immediate-loading or immobilized group (mean [and standard deviation], 813.0 ± 24.9 mg/mL compared with 778.4 ± 32.6 mg/mL and 784.9 ± 26.4 mg/mL, respectively; p < 0.05). There was a trend toward greater bone volume per total volume fraction in both the immobilized and the delayed-loading group compared with the immediate-loading group (0.24 ± 0.03 and 0.23 ± 0.06 compared with 0.20 ± 0.05; p = 0.06). Trabecular thickness was greater in the immobilized group compared with the immediate-loading group (106.5 ± 23.0 ?m compared with 72.6 ± 10.6 ?m; p < 0.01). There were no significant differences in failure load or stiffness between the immobilized group and either high-strain cyclic-loading group. Conclusions: Immediate application of high-strain loading appears to have a detrimental effect on healing in this rat model. Any beneficial effects of delayed loading on the healing tendon-bone interface (after a brief period of immobilization) may be offset by the detrimental effects of excessive strain levels or by the detrimental effects of stress deprivation on the graft. Clinical Relevance: The timing and magnitude of mechanical load on a healing rat ACL reconstruction graft may have important implications for postoperative rehabilitation. Avoidance of exercises that cause high graft strain in the early postoperative period may lead to improved tendon-to-bone healing in humans. PMID:24806014

  16. The Influence of Age on the M Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes

    PubMed Central

    Myer, Gregory D.; Sugimoto, Dai; Thomas, Staci; Hewett, Timothy E.

    2014-01-01

    Background In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated. Hypothesis/Purpose The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations. Study Design Meta-analysis; Level of evidence 1a. Methods Data were pooled from 14 clinical trials that met the inclusion criteria of (1) number of ACL injuries reported; (2) NMT program used; (3) female participants were included; (4) investigations used prospective, controlled trials; and (5) age of participants was documented or was obtainable upon contact with the authors. A meta-analysis with odds ratio (OR) was used to compare the ratios of ACL injuries between intervention and control groups among differing age categorizations. Results A meta-analysis of the 14 included studies demonstrated significantly greater knee injury reduction in female athletes who were categorized in the preventive NMT group compared with those who were in the control group (OR: 0.54; 95% confidence interval [CI]: 0.35, 0.83). Lower ACL injuries in mid-teens (OR 0.28; CI: 0.18, 0.42) compared with late teens (OR 0.48; CI: 0.21, 1.07) and early adults (OR 1.01; CI: 0.62, 1.64) were found in participants undergoing NMT. Conclusion The findings of this meta-analysis revealed an age-related association between NMT implementation and reduction of ACL incidence. Both biomechanical and the current epidemiological data indicate that the potential window of opportunity for optimized ACL injury risk reduction may be before the onset of neuromuscular deficits and peak knee injury incidence in female athletes. Specifically, it may be optimal to initiate integrative NMT programs during early adolescence, before the period of altered mechanics that increase injury risk. PMID:23048042

  17. Quadriceps Muscle Function After Exercise in Men and Women With a History of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kuenze, Christopher M.; Hertel, Jay; Hart, Joseph M.

    2014-01-01

    Context: Sex differences in lower extremity neuromuscular function have been reported after anterior cruciate ligament reconstruction (ACLR). Research evidence supports different levels of fatigability in men and women and between patients with ACLR and healthy controls. The influence of sex on the response to continuous exercise in patients with ACLR is not clear. Objective: To compare quadriceps neuromuscular function after exercise between men and women with ACLR. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: Twenty-six active volunteers (13 men [50%]: age = 24.1 ± 4.4 years, height = 179.1 ± 9.8 cm, mass = 80.1 ± 9.4 kg, months since surgery = 43.5 ± 37.0; 13 women [50%]: age = 24.2 ± 5.6 years, height = 163.0 ± 5.9 cm, mass = 62.3 ± 8.3 kg, months since surgery = 45.8 ± 42.7) with a history of unilateral primary ACLR at least 6 months earlier. Intervention(s): Thirty minutes of continuous exercise comprising 5 separate 6-minute cycles, including 5 minutes of uphill walking and 1 minute of body-weight squatting and step-ups. Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction torque, quadriceps superimposed-burst torque, and quadriceps central activation ratio before and after exercise. We performed separate 2 (sex: men, women) × 2 (time: preexercise, postexercise) repeated-measures analyses of variance for the 3 variables. Separate, independent-samples t tests were calculated to compare preexercise with postexercise change in all dependent variables between sexes. Results: A significant group-by-time interaction was present for knee-extension torque (P = .04). The percentage reduction in knee-extension maximal voluntary isometric contraction torque (men = 1.94%, women = ?10.32%; P = .02) and quadriceps central activation ratio (men = ?1.45%, women = ?8.69%; P = .03) experienced by men was less than that observed in women. Conclusions: In the presence of quadriceps dysfunction, female participants experienced greater-magnitude reductions in quadriceps function after 30 minutes of exercise than male participants. This indicates a reduced ability to absorb knee-joint loads, which may have significant implications for reinjury and joint osteoarthritis in women after ACLR. PMID:25243735

  18. Sex Influences the Biomechanical Outcomes of Anterior Cruciate Ligament Reconstruction in a Pre-Clinical Large Animal Model

    PubMed Central

    Kiapour, Ata M.; Fleming, Braden C.; Proffen, Benedikt L.; Murray, Martha M.

    2015-01-01

    Background The risk of anterior cruciate ligament (ACL) injury is 2-10 times greater in women than men. While the role of sex on injury risk is well established, its effects on surgical outcomes remain controversial. Purpose To investigate whether the biomechanical outcomes of ACL reconstruction are affected by sex using an established porcine model that displays similar sex-specific differences in knee anatomy and ligament structural properties to humans. We hypothesized there are sex differences in ACL reconstruction outcomes with regards to the graft structural properties, knee laxity and cartilage damage. Study Design Controlled Laboratory Study. Methods A total of 41 (23 M, 18 F) adolescent Yucatan minipigs underwent unilateral ACL transection and ACL reconstruction using sex-matched bone-patellar tendon-bone allografts (with or without additional bio-enhancement). Graft biomechanical and histological properties, knee laxity and cartilage damage were assessed after 15 weeks. A two-factor ANOVA was used to investigate the effect of sex on all the measured outcomes after adjusting for the treatment effect. Results After 15 weeks of healing, female pigs had a significantly lower mean normalized graft yield load (by 18.5±7.7%; p=0.023) and linear stiffness (by 11.9±5.6%; p=0.043), compared to males. Female pigs had a significantly greater side-to-side differences in AP knee laxity at 30° (by 1.4±0.6 mm; p=0.028) and 90° (by 1.8±0.8 mm; p=0.032). Female pigs had a lower graft vascular density (by 0.8±0.3 [analog scoring];p=0.021) with similar cellular and collagen-based histologic scores in both sexes (p>0.6). Female pigs also had a significantly larger area of cartilage damage (by 43.3±14.8 mm2; p=0.014) after conventional ACL reconstruction than their male counterparts. Conclusion Female pigs had significantly worse outcomes (i.e., graft structural properties, knee laxity and cartilage damage) compared to males in this translational model after 15 weeks of healing. Clinical Relevance These data suggest that further optimization of ACL injury treatments may be needed to accommodate each sex instead of using a “one fits all” approach to improve surgical outcomes, decrease incidence of re-injury, and decrease posttraumatic osteoarthritis risk following ACL reconstruction. PMID:25939612

  19. Individuals With an Anterior Cruciate Ligament-Deficient Knee Classified as Noncopers May Be Candidates for Nonsurgical Rehabilitation

    PubMed Central

    MOKSNES, HÅVARD; SNYDER-MACKLER, LYNN; RISBERG, MAY ARNA

    2009-01-01

    STUDY DESIGN Prospective cohort study. OBJECTIVES First, to classify a group of individuals with an anterior cruciate ligament (ACL)-deficient knee as potential copers or potential noncopers, based on an established screening examination. Second, to prospectively follow a cohort of individuals with an ACL injury and characterize the nonoperatively treated subjects as true copers and true noncopers 1 year after injury, and evaluate the outcomes in operatively treated individuals 1 year after ACL reconstruction. Finally, to calculate the predictive value of the screening examination based on a 1-year follow-up of the group of subjects with ACL tears treated nonoperatively. BACKGROUND A screening examination has been developed for early classification of individuals with ACL injuries. Potential copers have successfully been identified as rehabilitation candidates and have shown that they are able to continue preinjury activities without ACL reconstruction (true copers). However, the potential of individuals identified as noncopers to become true copers has not been studied. METHODS AND MEASURES One hundred twenty-five subjects with ACL injury were evaluated using a screening examination consisting of 4 single-legged hop tests, the Knee Outcome Survey activities of daily living scale, the global rating of knee function, and the number of episodes of giving way. Knee laxity measurements, the international knee documentation committee subjective knee form (IKDC2000), and return to sport were included as outcome measurements. RESULTS Thirty-seven percent (n = 46) of the subjects with ACL Injury were classified as potential copers at the screening examination. Of the 102 subjects examined at follow-up, 51% (n = 52) had undergone nonoperative treatment. Sixty-five percent (n = 34) of the nonoperated subjects were classified as true copers at the 1-year follow-up. Among the potential copers, 60% were true copers, while 70% of the subjects initially classified as potential noncopers were true copers at the 1-year follow-up. The positive predictive value for correctly classifying true copers at the screening examination was 60% (95% confidence interval: 41%–78%), while the negative predictive value was 30% (95% confidence interval: 16%–49%). CONCLUSION A majority (70%) of subjects classified as potential noncopers were true copers after 1 year following nonoperative treatment. Individuals with nonoperative treatment and ACL reconstruction showed excellent knee function and were highly active at the 1-year follow-up. The prognostic accuracy of this screening examination for correctly classifying true copers was poor. LEVEL OF EVIDENCE Prognosis, level 1b. PMID:18979658

  20. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series

    PubMed Central

    Centeno, Christopher J; Pitts, John; Al-Sayegh, Hasan; Freeman, Michael D

    2015-01-01

    Introduction This was a prospective case series designed to investigate treatment for anterior cruciate ligament (ACL) tears using an injection of autologous bone marrow concentrate. Methods Consecutive adult patients presenting to a private outpatient interventional musculoskeletal and pain practice with knee pain, ACL laxity on exam, and magnetic resonance imaging (MRI) evidence of a grade 1, 2, or 3 ACL tears with less than 1 cm retraction were eligible for this study. Eligible patients were treated with an intraligamentous injection of autologous bone marrow concentrate, using fluoroscopic guidance. Pre- and postprocedural sagittal MRI images of the ACLs were analyzed using ImageJ software to objectively quantify changes between pre- and posttreatment scans. Five different types of measurement of ACL pixel intensity were examined as a proxy for ligament integrity. In addition pain visual analog scale (VAS) and Lower Extremity Functional Scale (LEFS) values were recorded at baseline and at 1 month, 3 months, 6 months, and annually postinjection. Objective outcomes measured were pre- to post-MRI measurement changes, as analyzed by the ImageJ software. Subjective outcomes measured were changes in the VAS and LEFS, and a self-rated percentage improvement. Results Seven of ten patients showed improvement in at least four of five objective measures of ACL integrity in their postprocedure MRIs. In the entire study group, the mean gray value, median, raw integrated density, and modal gray value all decreased toward low-signal ACLs (P=0.01, P=0.02, P=0.002, and P=0.08), indications of improved ligament integrity. Seven of ten patients responded to the self-rated metrics follow up. The mean VAS change was a decrease of 1.7 (P=0.25), the mean LEFS change was an increase of 23.3 (P=0.03), and mean reported improvement was 86.7%. Conclusion Based on this small case series, autologous bone marrow concentrate shows promise in the treatment of grade 1, 2, and possibly grade 3 ACL tears without retraction. Further investigation using a controlled study design is warranted. PMID:26261424

  1. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects.

    PubMed

    Dingenen, Bart; Janssens, Luc; Luyckx, Thomas; Claes, Steven; Bellemans, Johan; Staes, Filip F

    2015-12-01

    The goal of this study was to evaluate muscle activation onset times (MAOT) of both legs during a transition task from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament injured (ACLI) (n=15) and non-injured control subjects (n=15) with eyes open and eyes closed. Significantly delayed MAOT were found in the ACLI group compared to the control group for vastus lateralis, vastus medialis obliquus, hamstrings medial, hamstrings lateral, tibialis anterior, peroneus longus and gastrocnemius in both vision conditions, for gluteus maximus and gluteus medius with eyes open and for tensor fascia latae with eyes closed. Within the ACLI group, delayed MAOT of tibialis anterior with eyes open and gastrocnemius with eyes closed were found in the injured leg compared to the non-injured leg. All other muscles were not significantly different between legs. In conclusion, the ACLI group showed delayed MAOT not only around the knee, but also at the hip and ankle muscles compared to the non-injured control group. No differences between both legs of the ACLI group were found, except for tibialis anterior and gastrocnemius. These findings indirectly support including central nervous system re-education training to target the underlying mechanisms of these altered MAOT after ACL injury. PMID:26409102

  2. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

  3. The uncertainty of predicting intact anterior cruciate ligament degeneration in terms of structural properties using T(2)(*) relaxometry in a human cadaveric model.

    PubMed

    Biercevicz, A M; Akelman, M R; Rubin, L E; Walsh, E G; Merck, D; Fleming, B C

    2015-04-13

    The combination of healing anterior cruciate ligament (ACL) volume and the distributions of T2(*) relaxation times within it have been shown to predict the biomechanical failure properties in a porcine model. This MR-based prediction model has not yet been used to assess ligament degeneration in the aging human knee. Using a set of 15 human cadaveric knees of varying ages, we obtained in situ MR measures of volume and T2(*) of the intact ACL and then related these MR variables to biomechanical outcomes (maximum and yield loads, linear stiffness) obtained via ex vivo failure testing. Using volume in conjunction with the median T2(*) value, the multiple linear regression model did not predict maximum failure load for the intact human ACL; R(2)=0.23, p=0.200. Similar insignificant results were found for yield load and linear stiffness. Naturally restricted distributions of the intact ligament volume and T2(*) (demonstrated by the respective Z-scores) in an older cadaveric population were the likely reason for the insignificant results. These restricted distributions may negatively affect the ability to detect a correlation when one exists. Further research is necessary to understand the relationship of MRI variables and ligament degeneration. While this study failed to find a significant prediction of human biomechanical outcome using these MR variables, with further research, an MR-based approach may offer a tool to longitudinally assess changes in cruciate ligament degradation. PMID:25746575

  4. Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee.

    PubMed

    Sutter, E Grant; Anderson, John A; Garrett, William E

    2015-04-01

    Improper femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is a significant problem and may be a cause of ACL graft failure and abnormal kinematics, which may lead to late degenerative changes after reconstruction. Recently, there has been concern that the transtibial approach may contribute to nonanatomic placement of the femoral tunnel, resulting in abnormal knee kinematics. Tibial-independent techniques can provide more anatomic placement of the ACL graft, but these can be technically demanding. This technical note describes the senior author's technique to directly identify the femoral ACL remnant and use the center of the femoral ACL footprint and retrograde drilling to create an anatomic femoral socket for single-bundle reconstruction. This technique provides femoral tunnel placement based on identification of a patient-specific ACL footprint instead of averaged anatomic measurements from large groups. This technique has been shown to produce anatomic ACL graft position and orientation and restore more normal knee kinematics. PMID:26052485

  5. Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient.

    PubMed

    Tei, Katsumasa; Kubo, Seiji; Matsumoto, Tomoyuki; Matsushita, Takehiko; Matsumoto, Akio; Kurosaka, Masahiro; Kuroda, Ryosuke

    2012-02-01

    A case of a 14-year-old boy with a rare injury--an osteochondral fracture of the posterolateral tibial plateau associated with the anterior cruciate ligament (ACL) rapture, and Segond fracture characterized by an avulsion fracture of the lateral tibial plateau--is reported. This case was noteworthy because it involved a rare combination of ACL injuries. This injury was thought to be caused by the impaction between the posterior aspect of the lateral tibial plateau and the lateral femoral condyle during internal rotational displacement of the knee joint at the time of injury, because the osteochondral fracture of the posterolateral tibial plateau matched the site where the bone bruise was observed. PMID:21559846

  6. An Anterior Cruciate Ligament Reconstruction Technique With 4-Strand Semitendinosus Grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices

    PubMed Central

    Colombet, Philippe; Graveleau, Nicolas

    2015-01-01

    We describe an anatomic single-bundle anterior cruciate ligament reconstruction using a 4-strand semitendinosus graft fixed with 2 Pullup adjustable suspensory fixation systems (SBM, Lourdes, France). Outside-in full tibial tunnel drilling represents a secure option for length management of the graft. The preferred graft choice is a 4-strand semitendinosus autologous graft. A special technique is used to stitch the graft with a figure-of-8 stitch to load the 4 strands. The Pullup adjustable loop is equipped with 2 buttons of different sizes: a small button for the standard Pullup system on the femoral side and a large button for the Pullup XL system on the tibial side. With this method, graft tension is equally distributed among the 4 strands and the graft cannot bottom out in the tibial tunnel in case of inadequate graft length. PMID:26697313

  7. Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

    PubMed Central

    Suomalainen, Piia; Kiekara, Tommi; Moisala, Anna-Stina; Paakkala, Antti; Kannus, Pekka; Järvelä, Timo

    2014-01-01

    Purpose The purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI) findings of a reconstructed anterior cruciate ligament (ACL) have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee. Methods This study is a level II, prospective clinical and MRI study (NCT02000258). The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used. Results We found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations. Conclusion Anterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this has no effect on the clinical recovery of the patient. PMID:25249760

  8. Results of Arthroscopic Bankart Lesion Repair in Patients with Post-Traumatic Anterior Instability of the Shoulder and a Non-Engaging Hill-Sachs Lesion with a Suture Anchor after a Minimum of 6-Year Follow-Up

    PubMed Central

    Szyluk, Karol; Jasi?ski, Andrzej; Widuchowski, Wojciech; Mielnik, Micha?; Koczy, Bogdan

    2015-01-01

    Background Shoulder instability is an important clinical problem. Arthroscopic surgery is an established treatment modality in shoulder instability, but it continues to be associated with a high rate of recurrences and complications. The purpose of the study was to analyze late outcomes of arthroscopic repair of Bankart lesions in patients with post-traumatic anterior shoulder instability and non-engaging Hill-Sachs lesion, with special focus on the incidence and causes of recurrences and complications. Material/Methods We investigated 92 patients (92 shoulders) who underwent surgery on account of post-traumatic anterior shoulder instability. The duration of follow-up ranged from 6 to 12.5 years (mean: 8.2 years). All patients were operated on in the lateral decubitus position using FASTak 2.8-mm suture anchors (FASTak, Arthrex, Naples, Florida). Treatment outcomes were evaluated using the Rowe and University of California at Los Angeles rating system (UCLA). Results According to Rowe scores, there were 71 (81.5%) excellent, 12 (12.6%) good, 5 (5.3%) satisfactory, and 2 (2.1%) poor results. Rowe scores improved in a statistically significant manner (p=0.00) post-surgery, to a mean of 90 (range: 25–100). Treatment outcomes measured as UCLA scores improved in a statistically significant manner (p=0.00), reaching post-operative levels of 12–35 (mean: 33.5). There were 9 recurrences, 1 case of axillary nerve praxia, and 1 case of anchor loosening. Conclusions With rigorous criteria for qualifying patients for surgery, arthroscopic treatment of post-traumatic anterior shoulder instability produces good outcomes and low recurrence and complication rates irrespective of the number of previous dislocations, age, or sex. PMID:26256225

  9. In Vivo Kinematics of the Anterior Cruciate Ligament Deficient Knee During Wide-Based Squat Using a 2D/3D Registration Technique

    PubMed Central

    Miyaji, Takeshi; Gamada, Kazuyoshi; Kidera, Kenichi; Ikuta, Futoshi; Yoneta, Kei; Shindo, Hiroyuki; Osaki, Makoto; Yonekura, Akihiko

    2012-01-01

    Anterior cruciate ligament (ACL) deficiency increases the risk of early osteoarthritis (OA). Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD) knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients with a unilateral ACLD knee consented to participate in this institutional review board approved study with the contralateral intact knee serving as the control. In vivo knee kinematics during the wide-based squat were analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Comparisons were performed using values between 0 and 100° flexion both in flexion and extension phases of the squat activity. Both the ACLD and intact knees demonstrated increasing tibial internal rotation with knee flexion, and no difference was observed in tibial rotation between the groups. The tibia in the ACLD knee was more anterior than that of the contralateral knees at 0 and 5° flexion in both phases (p < 0.05). Tibiofemoral medial contact points of the ACLD knees were more posterior than that of the contralateral knees at 5, 10 and 15° of knee flexion in the extension phase of the squat activity (p < 0.05). Tibiofemoral lateral contact points of the ACLD knees were more posterior than that of the contralateral knees at 0° flexion in the both phases (p < 0.05). The kinematics of the ACLD and contralateral intact knees were similar during the wide-based squat except at the low flexion angles. Therefore, we conclude the wide-based squat may be recommended for the ACLD knee by avoiding terminal extension. Key points In vivo knee kinematics during the wide-based squat was analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Significant differences of in vivo knee kinematics between the ACLD and contralateral knees were detected at low flexion angles. The wide-based squat is considered a safe exercise for the ACLD knee. PMID:24150081

  10. Topographical investigation of changes in depth-wise proteoglycan distribution in rabbit femoral articular cartilage at 4 weeks after transection of the anterior cruciate ligament.

    PubMed

    Arokoski, Mikko E A; Tiitu, Virpi; Jurvelin, Jukka S; Korhonen, Rami K; Fick, James M

    2015-09-01

    In this study, we explore topographical changes in proteoglycan distribution from femoral condylar cartilage in early osteoarthritis, acquired from both the lateral and medial condyles of anterior cruciate ligament transected (ACLT) and contralateral (CNTRL) rabbit knee joints, at 4 weeks post operation. Four sites across the cartilage surface in a parasagittal plane were defined across tissue sections taken from femoral condyles, and proteoglycan (PG) content was quantified using digital densitometry. The greatest depth-wise change in PG content due to an ACLT (compared to the CNTRL group) was observed anteriorly (site C) from the most weight-bearing location within the lateral compartment. In the medial compartment, the greatest change was observed in the most weight-bearing location (site B). The depth-wise changes in PG content were observed up to 48% and 28% depth from the tissue surface at these aforementioned sites, respectively (p?

  11. Anterior cruciate ligament strain and tensile forces for weight-bearing and non-weight-bearing exercises: a guide to exercise selection.

    PubMed

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-03-01

    There is a growing body of evidence documenting loads applied to the anterior cruciate ligament (ACL) for weight-bearing and non-weight-bearing exercises. ACL loading has been quantified by inverse dynamics techniques that measure anterior shear force at the tibiofemoral joint (net force primarily restrained by the ACL), ACL strain (defined as change in ACL length with respect to original length and expressed as a percentage) measured directly in vivo, and ACL tensile force estimated through mathematical modeling and computer optimization techniques. A review of the biomechanical literature indicates the following: ACL loading is generally greater with non-weight-bearing compared to weight-bearing exercises; with both types of exercises, the ACL is loaded to a greater extent between 10° to 50° of knee flexion (generally peaking between 10° and 30°) compared to 50° to 100° of knee flexion; and loads on the ACL change according to exercise technique (such as trunk position). Squatting with excessive forward movement of the knees beyond the toes and with the heels off the ground tends to increase ACL loading. Squatting and lunging with a forward trunk tilt tend to decrease ACL loading, likely due to increased hamstrings activity. During seated knee extension, ACL force decreases when the resistance pad is positioned more proximal on the anterior aspect of the lower leg, away from the ankle. The evidence reviewed as part of this manuscript provides objective data by which to rank exercises based on loading applied to the ACL. The biggest challenge in exercise selection post-ACL reconstruction is the limited knowledge of the optimal amount of stress that should be applied to the ACL graft as it goes through its initial incorporation and eventual maturation process. Clinicians may utilize this review as a guide to exercise selection and rehabilitation progression for patients post-ACL reconstruction. PMID:22387600

  12. Dosage Effects of Neuromuscular Training Intervention to Reduce Anterior Cruciate Ligament Injuries in Female Athletes: Meta-and Sub-group Analyses

    PubMed Central

    Sugimoto, Dai; Myer, Gregory D.; Barber Foss, Kim D.; Hewett, Timothy E.

    2014-01-01

    Background Although a series of meta-analysis demonstrated neuromuscular training (NMT) is an effective intervention to reduce anterior cruciate ligament (ACL) injury in female athletes, the potential existence of a dosage effect remains unknown. Objective To systematically review previously published clinical trials and evaluate potential dosage effects of NMT for ACL injury reduction in female athletes. Design Meta- and Sub-group analyses Setting The key words “knee”, “anterior cruciate ligament”, “ACL”, “prospective”, “neuromuscular”, “training”, “female”, and “prevention” were utilized in PubMed and EBSCO host for studies published between 1995 and May 2012. Participants Inclusion criteria set for studies in the current analysis were: 1) recruited female athletes as subjects, 2) documented the number of ACL injuries, 3) employed a NMT intervention aimed to reduce ACL injuries, 4) had a control group, 5) used a prospective control trial design and 6) provided NMT session duration and frequency information. Main outcome measures The number of ACL injuries and female athletes in each group (control and intervention) were compared based on duration, frequency, and volume of NMT through odds ratio (OR). Results A total of 14 studies were reviewed. Analyses that compared the number of ACL injuries with short versus long NMT duration showed greater ACL injury reduction in female athletes who were in the long NMT duration (OR:0.35, 95%CI: 0.23, 0.53, p=0.001) than the short NMT duration (OR: 0.61, 95%CI: 0.41, 0.90, p=0.013) group. Analysis that compared single versus multi NMT frequency indicated greater ACL injury reduction in multi NMT frequency (OR: 0.35, 95%CI: 0.23, 0.53, p=0.001) compared to single NMT frequency (OR: 0.62, 95%CI:0.41, 0.94, p=0.024). Combining the duration and frequency of NMT programs, an inverse dose-response association emerged among low (OR: 0.66, 95%CI: 0.43, 0.99, p=0.045), moderate (OR: 0.46, 95%CI: 0.21, 1.03, p=0.059), and high (OR:0.32, 95%CI: 0.19, 0.52, p=0.001) NMT volume categories. Conclusions The inverse dose-response association observed in the subgroup analysis suggests that the higher NMT volume, the greater prophylactic effectiveness of the NMT program and increased benefit in ACL injury reduction among female athletes. PMID:24370992

  13. Visualization and reduction of a mensical capsular junction tear in the knee: an arthroscopic surgical technique.

    PubMed

    Plymale, Mickey; Fleisig, Glenn S; Kocaj, Stephen M; Cooney, William P; Evans, Timothy J; Cain, E Lyle; Dugas, Jeffrey R

    2014-11-01

    Meniscal injuries commonly occur concomitantly with anterior cruciate ligament (ACL) injuries. Although many types of meniscal injuries have been described in the literature, there has not been much focus on meniscal capsular junction (MCJ) tears. This lack of attention is concerning given that, in a survey of 67 orthopedic surgeons, 88% indicated that MCJ tears could be a source of chronic pain. In addition, we reviewed 781 ACL reconstructions at our clinic and found a 12.3% incidence of MCJ tear with primary ACL injury and a 23.6% incidence of MCJ tear with revision ACL reconstruction. In this article, we describe an arthroscopic repair technique for MCJ tears at the posterior aspect of the medial meniscus root. The repair uses an accessory posterior medial portal. The technique can also be used for significant posterior medial capsular tears. PMID:25379745

  14. Arthroscopic Femoral Neck Osteoplasty in the Treatment of Femoroacetabular Impingement

    PubMed Central

    Chow, Roxanne M.; Kuzma, Scott A.; Krych, Aaron J.; Levy, Bruce A.

    2013-01-01

    Femoral neck osteoplasty is an integral component for successful treatment of femoroacetabular impingement. Current techniques allow this to be performed arthroscopically, and results are equivalent to those of open procedures when typical anterior and anterosuperior lesions are considered. The arthroscopic procedure is dependent on obtaining adequate visualization through capsular management and proper leg positioning, and it requires fluoroscopy to guide and verify an adequate resection. We present our preferred technique for arthroscopic femoral neck osteoplasty. PMID:24749017

  15. Biomechanical Characteristics of an Implant Used to Secure Semitendinosus–Gracilis Tendon Grafts in a Canine Model of Extra-Articular Anterior Cruciate Ligament Reconstruction

    PubMed Central

    SPENCER, NAKIA; CASEY, JOHN P.; MONROE, WILLIAM TODD

    2007-01-01

    Objective To compare initial femoral fixation properties of a new implant, Graftgrab (GG), with 2 established methods of extra-articular femoral graft fixation, spiked washers (SW) and bone staples (ST). Study Design Experimental in vitro cohort study. Methods Canine semitendinosus–gracilis tendon grafts were passed through bone tunnels and fixed to the lateral surface of femoral condyles with spiked washers, bone staples, or new implant prototypes. The fixations were tested to failure with a single-cycle load at a rate of 50 mm/min. Failure and yield strength, stiffness, energy, and elongation were determined from load–displacement curves and failure modes were recorded. Results The graft failed midsubstance in 4 SW, 4 ST, and 1 GG fixations. In 3 SW, 3 ST, and 1 GG specimens, the graft slipped from the fixation. The graft ruptured at the clip (3) and the intra-articular (2) surface of the bone tunnel in the remaining GG specimens. There were no significant differences between fixation groups in femoral tunnel length, femoral width, or the mechanical properties evaluated. Conclusions The initial in vitro mechanical properties of the new fixation implant are comparable with those of spiked washers and bone staples. Clinical Relevance The initial mechanical performance of the new implant tested in this study was similar to those of comparable, established implants. The new implant is novel and may be useful for human anterior and veterinary cranial cruciate ligament graft reconstruction fixation. PMID:17686135

  16. Anterior cruciate ligament reconstruction with the patellar tendon--augmentation or not? A 2-year follow-up of 82 patients.

    PubMed

    Thuresson, P; Sandberg, R; Johansson, O; Balkfors, B; Westlin, N

    1996-08-01

    The aim of this bi-centre study was to assess the possible effects of the addition of the Kennedy ligament augmentation device (LAD) in the reconstruction of the anterior cruciate ligament (ACL). The method of reconstruction used was a modification of the Brückner and Broström procedures, using the medial third of the patellar tendon tunnelled through the proximal tibia into the lateral femoral condyle and fastened with pull-out sutures. Eighty-two patients with chronic ACL insufficiency and severe symptoms of instability in spite of physiotherapy were randomly selected for reconstruction with or without a LAD. The LAD-augmented knees had the synthetic augmentation stitched to and embedded into the autogenous tissue and the composite graft was pulled through a femoral tunnel and stapled proximally. The patients were followed up regularly and the 2-year results are presented here. The outcome in both groups was good. The augmented-knee group had a larger extension deficit 1 month post-operatively compared to the non-augmented knee group but a smaller extension deficit at the 2-year follow-up. There was no difference in the median of the Lysholm knee function score but there were more patients in the non-augmented group with a lower Lysholm knee function score at the 2-year follow-up. PMID:8896099

  17. Does the A9285G Polymorphism in Collagen Type XII ?1 Gene Associate with the Risk of Anterior Cruciate Ligament Ruptures?

    PubMed Central

    Ficek, K; Stepien-Slodkowska, M; Kaczmarczyk, M; Maciejewska-Karlowska, A; Sawczuk, M; Cholewinski, J; Leonska-Duniec, A; Zarebska, A; Cieszczyk, P; Zmijewski, P

    2014-01-01

    One of the most severe injuries sustained by athletes is rupture of the anterior cruciate ligament (ACL). Recent investigations suggest that a predisposition for ACL rupture may be the result of specific genetic sequence variants. In light of this, we decided to investigate whether the COL12A1 A9285G polymorphism was associated with ACL ruptures in Polish football players. We compared genotypic and allelic frequencies of the COL12A1 A9285G polymorphism in two groups of athletes: 91 male football players (23 ± 3 years) with surgically diagnosed primary ACL ruptures who qualified for ligament reconstruction (cases) and 143 apparently healthy, male football players of the same ethnicity, a similar age category, and a comparable level of exposure to ACL injury, who were without any self-reported history of ligament or tendon injury (controls). DNA samples extracted from the oral epithelial cells were genotyped by using a real-time polymerase chain reaction (Ri-Ti-PCR) method. The genotype distribution in the cases were not different from those in controls (p = 0.70). The frequency of the G allele was lower in the cases (18.1%) but not statistically significant (p = 0.40) when compared with controls (21.3%). Our results are in contradiction to the hypothesis that the COL12A1 A9285G polymorphism is associated with a predisposition for ACL injury. However, these conclusions should be supported with more experimental studies on COL12A1 polymorphisms. PMID:25741214

  18. Examination of a biodegradable magnesium screw for the reconstruction of the anterior cruciate ligament: A pilot in vivo study in rabbits.

    PubMed

    Diekmann, Julia; Bauer, Sylvie; Weizbauer, Andreas; Willbold, Elmar; Windhagen, Henning; Helmecke, Patrick; Lucas, Arne; Reifenrath, Janin; Nolte, Ingo; Ezechieli, Marco

    2016-02-01

    The reconstruction of the anterior cruciate ligament is, for the most part, currently performed with interference screws made of titanium or degradable polymers. The aim of this study was to investigate the use of biodegradable magnesium interference screws for such a procedure because of their known biocompatibility and reported osteoconductive effects. The left tibiae of each of 18 rabbits were implanted with a magnesium-based (MgYREZr-alloy) screw, and another 18 with a titanium-based control. Each group was divided into observation periods of 4, 12 and 24weeks. After sacrifice, ?CT scans were acquired to assess the amount of the gas liberated and the degradation rate of the implant. Histological evaluations were performed to investigate the local tissue response adjacent to the implant and to assess the status of the attachment between the tendon and the bone tissue. The ?CT scans showed that liberation of gas was most prominent 4weeks after implantation and was significantly decreased by 24weeks. All screws remained in situ and formed a sufficient connection with the tendon and sufficient osseous integration at 24weeks. Histological evaluations showed neither inflammatory reactions nor necrosis of the tendon. The results of this pilot study in rabbits indicate that this magnesium-based interference screw should be considered as an alternative to conventional implant materials. PMID:26652469

  19. Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles

    PubMed Central

    Koo, Seungbum; Kyung, Bong Soo; Jeong, Ju Seon; Suh, Dong Won; Ahn, Jin Hwan

    2015-01-01

    Purpose To evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy. Materials and Methods Ten patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed. Results The average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5±4.2 mm) was significantly greater than that of the contralateral knees (7.7±3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides. Conclusions During the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle. PMID:26389073

  20. Isokinetic dynamometer evaluation of the effects of early thigh diameter difference on thigh muscle strength in patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft

    PubMed Central

    K?l?nç, Bekir Eray; Kara, Adnan; Camur, Savas; Oc, Yunus; Celik, Haluk

    2015-01-01

    After anterior cruciate ligament (ACL) reconstruction, which muscle groups are more affected from frequently developing thigh muscle atrophy is a matter of debate. We evaluate the effect of thigh circumference difference between patients’ knees who were administered the ACL reconstruction with hamstring tendon autograft and intact knees, on torque between the hamstring and quadriceps muscles. Fifty-five patients at least 6 months follow-up period available were included in our study. Power measurements of quadriceps and hamstring muscle groups in patients’ extremities were done by using isokinetic dynamometer. The maximum torque values at 60°/sec, 240°/sec in frequency, positions of flexion and extension were determined. In accordance with our findings it is still possible to encounter the thigh atrophy in average 28 months after ACL reconstruction surgery even under physical rehabilitation programs and appropriate follow-up. It is inevitable for the clinician to consider these changes in diagnosis and rehabilitation stages. It can’t be ignored that muscle weakness mechanisms developing in the thigh circumference vary according to the thigh muscle group and knee flexors play an important role in thigh atrophy when determining an appropriate rehabilitation program after reconstruction application. PMID:25960982

  1. Effect of culture complex of BMSCs and sodium hydroxide- and GRGDSPC-treated PET on the reconstruction of injured anterior cruciate ligament in a rabbit model

    PubMed Central

    Huang, Jianming; Chen, Fengrong; Jian, Guojian; Ye, Zhiyang; Wang, Zimin; Liu, Haoyuan; Kang, Yifan

    2015-01-01

    Ligament reconstruction is an effective therapy for anterior cruciate ligament (ACL) rupture. Polyethylene terephthalate (PET) artificial ligaments have recently gained popularity in clinical ACL reconstruction for its advantage in the improvement of keen function. However, the application of PET in clinical treatment is limited by its poor bioactivity and biocompatibility. Recently, bone marrow-derived mesenchymal stem cells (BMSCs) have been widely studied in regenerative medical therapy due to their multi-lineage differentiation. Previous study also indicated that BMSCs may promote the healing of tendon-bone interface of injured ligament. We speculate that BMSCs may enhance the curative effect of PET artificial ligament on the tendon-bone-healing in ligament reconstruction. In this study, the PET materials were first modified with sodium hydroxide hydrolysis and GRGDSPC peptide which was able to improve its bioactivity and biocompatibility. Then, the effects of modified PET materials on the adhesion, proliferation and differentiation of BMSCs were examined. The in vitro co-culture of BMSCs and modified PET showed the modified PET promoted the adhesion, proliferation and differentiation of BMSCs. Further, the effect of culture complex of BMSCs and modified PET artificial ligament co-culture system on the injured ligament reconstruction was investigated in vivo. Results showed not only better growth and differentiation of BMSCs but also satisfactory healing of the injured ligament was observed after implantation of this culture complex into the injured ligament of rabbits. Our study provides a brand-new solution for ACL reconstruction. PMID:26221227

  2. Feedback Techniques to Target Functional Deficits Following Anterior Cruciate Ligament Reconstruction: Implications for Motor Control and Reduction of Second Injury Risk

    PubMed Central

    Benjaminse, Anne; Hewett, Timothy E.; Paterno, Mark V.; Ford, Kevin R.; Otten, Egbert; Myer, Gregory D.

    2014-01-01

    Primary anterior cruciate ligament (ACL) injury prevention training has been shown to reduce the risk of injury. Less is known about the effect of prevention on second injury after ACL reconstruction (ACLR). Given recent findings that second injury rates exceed 20 % in only the first year following the return to sport, it is imperative that rehabilitation after ACLR is scrutinized so that second injury preventative strategies can be optimized. A potential limitation of current rehabilitative processes following ACLR could be a deficiency in the transition from conscious awareness achieved during rehabilitation sessions to unexpected and automatic movements required for athletic activities on the field. Learning strategies with an internally directed focus have traditionally been utilized but may be less suitable for acquisition of control of complex motor skills required for sport reintegration. Conversely, an externally focused rehabilitation strategy may enhance skill acquisition more efficiently and increase the potential to transfer to competitive sport. This article presents new insights gained from the motor learning domain that may improve neuromuscular training programmes via increased retention from improved techniques and may ultimately reduce the incidence of second ACL injuries. PMID:24062274

  3. Single-Bundle Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Using the PINN-ACL CrossPin System: Minimum 4-Year Follow-up

    PubMed Central

    Baek, Seung-Gil; Lee, Byoung-Joo; Lee, Chang-Hwa

    2015-01-01

    Purpose This study evaluated mid-term results of anterior cruciate ligament (ACL) reconstruction using the PINN-ACL CrossPin system that allowed for short graft fixation. Materials and Methods Forty-three patients underwent single-bundle ACL reconstruction with a 4-strand semitendinosus tendon graft using the PINN-ACL CrossPin system. Femoral fixation was done using the PINN-ACL CrossPin system, and the tibial side was fixed with post-tie and a bioabsorbable interference screw. The mean follow-up period was 50 months. Evaluation was done using the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) score and grade. Anterior displacement was assessed. Results There was improvement in the Lachman test and pivot-shift test at final follow-up, form grade II (n=40) or III (n=3) to grade I (n=3) or 0 (n=40) and from grade I (n=20) or II (n=10) to grade I (n=8) or 0 (n=22), respectively. The mean IKDC score was 88.7, and grade A and B were 93.0% at final follow-up. Side-to-side difference was improved from 6.7 mm to 2.1 mm at final follow-up. Complications occurred in 3 patients, a re-ruptured due to trauma at 2 years after surgery and a deep infection and a superficial infection. Conclusions The mid-term follow-up results of ACL reconstruction with the PINN-ACL CrossPin system were satisfactory. The PINN-ACL CrossPin can be considered as a useful instrument for short graft fixation. PMID:25750893

  4. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases

    PubMed Central

    Waldén, Markus; Krosshaug, Tron; Bjørneboe, John; Andersen, Thor Einar; Faul, Oliver

    2015-01-01

    Background Current knowledge on anterior cruciate ligament (ACL) injury mechanisms in male football players is limited. Aim To describe ACL injury mechanisms in male professional football players using systematic video analysis. Methods We assessed videos from 39 complete ACL tears recorded via prospective professional football injury surveillance between 2001 and 2011. Five analysts independently reviewed all videos to estimate the time of initial foot contact with the ground and the time of ACL tear. We then analysed all videos according to a structured format describing the injury circumstances and lower limb joint biomechanics. Results Twenty-five injuries were non-contact, eight indirect contact and six direct contact injuries. We identified three main categories of non-contact and indirect contact injury situations: (1) pressing (n=11), (2) re-gaining balance after kicking (n=5) and (3) landing after heading (n=5). The fourth main injury situation was direct contact with the injured leg or knee (n=6). Knee valgus was frequently seen in the main categories of non-contact and indirect contact playing situations (n=11), but a dynamic valgus collapse was infrequent (n=3). This was in contrast to the tackling-induced direct contact situations where a knee valgus collapse occurred in all cases (n=3). Conclusions Eighty-five per cent of the ACL injuries in male professional football players resulted from non-contact or indirect contact mechanisms. The most common playing situation leading to injury was pressing followed by kicking and heading. Knee valgus was frequently seen regardless of the playing situation, but a dynamic valgus collapse was rare. PMID:25907183

  5. Knee Extension Range of Motion at 4 Weeks Is Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Noll, Sarah; Garrison, J. Craig; Bothwell, James; Conway, John E.

    2015-01-01

    Background: The anterior cruciate ligament (ACL) is commonly torn, and surgical reconstruction is often required to allow a patient to return to their prior level of activity. Avoiding range of motion (ROM) loss is a common goal, but little research has been done to identify when ROM loss becomes detrimental to a patient’s future function. Purpose: To determine whether there is a relationship between early knee side-to-side extension difference after ACL reconstruction and knee side-to-side extension difference at 12 weeks. The hypothesis was that early (within the first 8 weeks) knee side-to-side extension difference will be predictive of knee side-to-side extension difference seen at 12 weeks. Study Design: Cohort study; Level of evidence, 3. Methods: Knee side-to-side extension difference measures were taken on 74 patients undergoing ACL reconstruction rehabilitation at the initial visit and 4, 8, and 12 weeks postoperatively. Visual analog scores (VAS) and International Knee Documentation Committee (IKDC) scores were also recorded at these time frames. Results: There was a strong relationship between knee extension ROM at 4 and 12 weeks (r = 0.639, P < .001) and 8 and 12 weeks (r = 0.742, P < .001). When the variables of knee extension ROM at initial visit and 4 and 8 weeks were entered into a regression analysis, the predictor variable explained 61% (R2 = 0.611) of variance for knee extension ROM at 12 weeks, with 4 weeks (R2 = 0.259) explaining the majority of this variance. Conclusion: This study found that a patient’s knee extension at 4 weeks was strongly correlated with knee extension at 12 weeks. Clinical Relevance: This information may be useful for clinicians treating athletic patients who are anxious for return to sport by providing them an initial goal to work toward in hopes of ensuring successful rehabilitation of their knee.

  6. Elevated gastrocnemius forces compensate for decreased hamstrings forces during the weight-acceptance phase of single-leg jump landing: implications for anterior cruciate ligament injury risk.

    PubMed

    Morgan, Kristin D; Donnelly, Cyril J; Reinbolt, Jeffrey A

    2014-10-17

    Approximately 320,000 anterior cruciate ligament (ACL) injuries in the United States each year are non-contact injuries, with many occurring during a single-leg jump landing. To reduce ACL injury risk, one option is to improve muscle strength and/or the activation of muscles crossing the knee under elevated external loading. This study's purpose was to characterize the relative force production of the muscles supporting the knee during the weight-acceptance (WA) phase of single-leg jump landing and investigate the gastrocnemii forces compared to the hamstrings forces. Amateur male Western Australian Rules Football players completed a single-leg jump landing protocol and six participants were randomly chosen for further modeling and simulation. A three-dimensional, 14-segment, 37 degree-of-freedom, 92 muscle-tendon actuated model was created for each participant in OpenSim. Computed muscle control was used to generate 12 muscle-driven simulations, 2 trials per participant, of the WA phase of single-leg jump landing. A one-way ANOVA and Tukey post-hoc analysis showed both the quadriceps and gastrocnemii muscle force estimates were significantly greater than the hamstrings (p<0.001). Elevated gastrocnemii forces corresponded with increased joint compression and lower ACL forces. The elevated quadriceps and gastrocnemii forces during landing may represent a generalized muscle strategy to increase knee joint stiffness, protecting the knee and ACL from external knee loading and injury risk. These results contribute to our understanding of how muscle's function during single-leg jump landing and should serve as the foundation for novel muscle-targeted training intervention programs aimed to reduce ACL injuries in sport. PMID:25218505

  7. Efficacy test of Polycan, a beta-glucan originated from Aureobasidium pullulans SM-2001, on anterior cruciate ligament transection and partial medial meniscectomy-induced-osteoarthritis rats.

    PubMed

    Kim, Joo-Wan; Cho, Hyung-Rae; Ku, Sae-Kwang

    2012-02-01

    The object of this study was to assess the efficacy of Polycan from Aureobasidium pullulans SM-2001, which is composed mostly of beta-1,3-1,6-glucan, on osteoarthritis (OA)-induced by anterior cruciate ligament transection and partial medial meniscectomy (ACLT&PMM). Three different dosages of Polycan (85, 42.5, and 21.25 mg/kg) were orally administered once a day for 84 days to male rats a week after ACLT&PMM surgery. Changes in the circumference and maximum extension angle of each knee, and in cartilage histopathology were assessed using Mankin scores 12 weeks after Polycan administration. In addition, cartilage proliferation was evaluated using bromodeoxyuridine (BrdU). As the result of ACLT&PMM, classic OA was induced with increases in maximum extension angles, edematous knees changes, and capsule thickness, as well as decreases in chondrocyte proliferation, cartilages degenerative changes, and loss of articular cartilage. However, these changes (except for capsule thickness) were markedly inhibited in all Polycan- and diclofenac sodium-treated groups compared with OA control. Although diclofenac sodium did not influence BrdU uptake, BrdU-immunoreactive cells were increased with all dosages of Polycan, which means that Polycan treatment induced proliferation of chondrocytes in the surface articular cartilage of the tibia and femur. The results obtained in this study suggest that 84 days of continuous oral treatment of three different dosages of Polycan led to lesser degrees of articular stiffness and histological cartilage damage compared with OA controls 91 days after OA inducement, suggesting that the optimal Polycan dosage to treat OA is 42.5 mg/kg based on the present study. PMID:22370362

  8. Reconstruction of the anterior cruciate ligament: comparison of analgesia using intrathecal morphine, intra-articular morphine and intra-articular levobupivacaine?

    PubMed Central

    Pinheiro, Leandro Queiroz; Neri Junior, Edmundo; Fernandes, Reginaldo Mendonça; Cardozo, Rodrigo Tavares; Rezende, Priscila Rodrigues

    2015-01-01

    Objective To compare the analgesic effect of intra-articular administration of morphine and levobupivacaine (separately or in combination) with intrathecal administration of morphine in patients undergoing anterior cruciate ligament (ACL) reconstruction using autologous grafts from the patellar tendon. Methods This was a retrospective analysis on data gathered from the medical files of 60 patients aged 20 to 50 years who underwent knee video arthroscopy for ACL reconstruction. The patients were divided into four groups of 15 individuals (A, B, C and D) according to the agent administered into the joint and around the incision: 20 mL of saline solution with 5 mg of morphine in A; 20 mL of 0.5% levobupivacaine solution in B; 10 mL of solution with 2.5 mg of morphine plus 10 mL of 0.5% levobupivacaine solution in C; and morphine administered intrathecally in D. Results All the groups presented low pain scores during the first 12 h after the surgery. Groups B and C presented significantly greater pain scores than shown by group D (control), 24 h after the surgery. There was no statistical difference in pain scores between group A and group D. Conclusion The patients in group A presented analgesia comparable to that of the patients in group D, whereas the procedure of group C was no capable of reproducing the analgesic effect observed in group D, as observed 24 h after the surgery. Further studies are needed in order to show the exact mechanism of action, along with the ideal dose and concentration for applying opioids to joints. PMID:26229934

  9. Mechanisms of the Anterior Cruciate Ligament Injury in Sports Activities: A Twenty-Year Clinical Research of 1,700 Athletes

    PubMed Central

    Kobayashi, Hirokazu; Kanamura, Tomonao; Koshida, Sentaro; Miyashita, Koji; Okado, Tsuruo; Shimizu, Takuya; Yokoe, Kiyoshi

    2010-01-01

    The mechanisms of anterior cruciate ligament (ACL) injuries are still inconclusive from an epidemiological standpoint. An epidemiological approach in a large sample group over an appropriate period of years will be necessary to enhance the current knowledge of the ACL injury mechanism. The objective of the study was to investigate the ACL injury occurrence in a large sample over twenty years and demonstrate the relationships between the ACL injury occurrence and the dynamic knee alignment at the time of the injury. We investigated the activity, the injury mechanism, and the dynamic knee alignment at the time of the injury in 1,718 patients diagnosed as having the ACL injuries. Regarding the activity at the time of the injury, “competition ”was the most common, accounting for about half of all the injuries. The current result also showed that the noncontact injury was the most common, which was observed especially in many female athletes. Finally, the dynamic alignment of “Knee-in & Toe- out ”(i.e. dynamic knee valgus) was the most common, accounting for about half. These results enhance our understanding of the ACL injury mechanism and may be used to guide future injury prevention strategies. Key points We investigated the situation of ACL injury occurrence, especially dynamic alignments at the time of injury, in 1,718 patients who had visited our institution for surgery and physical therapy for twenty years. Our epidemiological study of the large patient group revealed that “knee-in & toe-out ”alignment was the most frequently seen at the time of the ACL injury. From an epidemiological standpoint, we need to pay much attention to avoiding “Knee-in & Toe-out ”alignment during sports activities. PMID:24149795

  10. A Comparison of the Fixation Strengths Provided by Different Intraosseous Tendon Lengths during Anterior Cruciate Ligament Reconstruction: A Biomechanical Study in a Porcine Tibial Model

    PubMed Central

    Yang, Dong-Lyul; Cheon, Sang-Ho; Oh, Chang-Wug

    2014-01-01

    Background The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. Methods Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 × 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. Results No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). Conclusions In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction. PMID:24900898

  11. A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: Investigation into the effects of fat reduction and bioburden reduction bioprocesses

    PubMed Central

    Herbert, Anthony; Jones, Gemma L.; Ingham, Eileen; Fisher, John

    2015-01-01

    The decellularisation of xenogenic and allogeneic biological grafts offers a promising solution to replacement of the anterior cruciate ligament (ACL). The purpose of this investigation was to determine the biomechanical effects of additional fat reduction and bioburden reduction steps in the decellularisation of porcine super flexor tendon (pSFT). Study 1 investigated the use of acetone or chloroform–methanol as a fat reduction agent. The most effective of these was then carried forward into Study 2, which investigated the use of antibiotics or peracetic acid (PAA) as a bioburden reduction agent. Stress relaxation data was analysed using a Maxwell–Wiechert viscoelastic model and, in addition to classical material properties, the tangent modulus of the toe-region was determined from strength testing data. In both studies, the majority of decellularised groups demonstrated no statistical differences for material properties such as tensile strength and Young’s modulus compared to native controls. Different trends were observed for many of the viscoelastic parameters, but also for the tangent modulus in the toe-region indicating a change in performance at low strains. The most severe deviations from the profile of the native tangent modulus were found to occur in Study 2 when PAA was used for bioburden reduction. Classic material properties (E, UTS etc.) are often used to compare the characteristics of native and decellularised tissues, however they may not highlight changes occurring in the tissues at low strains. In this study, this represented the physiological strains encountered by substitute acellular ACL grafts. Acetone was chosen as the fat reduction step whereas, antibiotics was preferable over PAA as a bioburden reduction step. PMID:25443884

  12. Effects of Neuromuscular Fatigue on Quadriceps Strength and Activation and Knee Biomechanics in Individuals Post-Anterior Cruciate Ligament Reconstruction and Healthy Adults.

    PubMed

    Thomas, Abbey C; Lepley, Lindsey K; Wojtys, Edward M; McLean, Scott G; Palmieri-Smith, Riann M

    2015-12-01

    Study Design Laboratory-based experiment using a pretest/posttest design. Objectives To determine the effects of neuromuscular fatigue on quadriceps strength and activation and sagittal and frontal plane knee biomechanics during dynamic landing following anterior cruciate ligament reconstruction (ACLR). Background Impaired quadriceps central activation occurs post-ACLR, likely altering lower extremity biomechanics. Neuromuscular fatigue similarly reduces volitional muscle activation and impairs neuromuscular control. Upon return to full activity post-ACLR, individuals likely concurrently experience quadriceps central activation deficits and neuromuscular fatigue, though the effects of fatigue on muscle strength and activation and biomechanics post-ACLR are unknown. Methods Seventeen individuals 7 to 10 months post-ACLR and 16 controls participated. Quadriceps strength and central activation ratio were recorded prefatigue and postfatigue, which was induced via sets of double-leg squats. Knee biomechanics were recorded during a dynamic landing activity prefatigue and postfatigue. Results Both groups demonstrated smaller knee flexion (initial contact, P = .017; peak, P = .004) and abduction (initial contact, P = .005; peak, P = .009) angles postfatigue. The ACLR group had smaller peak knee flexion angles (P<.001) prefatigue and postfatigue than controls. Knee flexion moment was smaller in those post-ACLR than controls prefatigue (P<.001), but not postfatigue (P = .103). Controls had smaller knee flexion moments postfatigue (P = .001). Knee abduction moment was smaller in both groups postfatigue (P = .003). All participants demonstrated significantly lower strength (P<.001) and activation (P = .003) postfatigue. Conclusion Impaired strength, central activation, and biomechanics were present postfatigue in both groups, suggesting that neuromuscular fatigue may increase noncontact ACL injury risk. However, these changes were not exaggerated in those post-ACLR, likely because they already demonstrated a stiff-legged landing strategy prefatigue. J Orthop Sports Phys Ther 2015;45(12):1042-1050. Epub 15 Oct 2015. doi:10.2519/jospt.2015.5785. PMID:26471851

  13. Simulated activity but real trauma: a systematic review on Nintendo Wii injuries based on a case report of an acute anterior cruciate ligament rupture.

    PubMed

    Müller, Sebastian A; Vavken, Patrick; Pagenstert, Geert

    2015-03-01

    Video gaming injuries are classically regarded as eccentric accidents and novelty diagnoses. A case of an anterior cruciate ligament (ACL) tear sustained during Wii boxing spurned us to review the literature for other Wii-related injuries and Wii-based posttraumatic rehabilitation. The English literature listed in PubMed was systematically reviewed by searching for "Wii (trauma or injury or fracture)." Full-text articles were included after duplicate, blinded review. The type and treatment of injury as well as the Wii-based rehabilitation programs found were analyzed. Additionally, a new case of an acute ACL tear-sustained playing, Wii boxing, is additionally presented. After exclusion of irrelevant articles, 13 articles describing Wii-related injuries were included reporting on 3 fractures, 6 nonosseous, 2 overuse injuries, and 2 rehabilitation programs using Wii for posttraumatic rehabilitation. Among the presented Wii-related injuries, only 12.5% were treated conservatively, whereas 87.5% underwent either surgical or interventional treatment. Because of the reported case, the literature search was limited to Wii-related injuries excluding other video games. Another limitation of this article lies in the fact that mainly case reports but no controlled trials exist on the topic. Assumingly, primarily the more severe injuries are reported in the literature with an unknown number of possibly minor injuries. Motion-controlled video games, such as Wii, are becoming increasingly popular as a recreational entertainment. Because of their wide acceptance and entertaining nature, they are also increasingly recognized as a tool in rehabilitation. However, although the activity is simulated, injuries are real. Our systematic review shows that Wii gaming can lead to severe injuries, sometimes with lasting limitations. PMID:25816033

  14. Simulated Activity But Real Trauma: A Systematic Review on Nintendo Wii Injuries Based on a Case Report of an Acute Anterior Cruciate Ligament Rupture

    PubMed Central

    Müller, Sebastian A.; Vavken, Patrick; Pagenstert, Geert

    2015-01-01

    Abstract Video gaming injuries are classically regarded as eccentric accidents and novelty diagnoses. A case of an anterior cruciate ligament (ACL) tear sustained during Wii boxing spurned us to review the literature for other Wii-related injuries and Wii-based posttraumatic rehabilitation. The English literature listed in PubMed was systematically reviewed by searching for “Wii (trauma or injury or fracture).” Full-text articles were included after duplicate, blinded review. The type and treatment of injury as well as the Wii-based rehabilitation programs found were analyzed. Additionally, a new case of an acute ACL tear-sustained playing, Wii boxing, is additionally presented. After exclusion of irrelevant articles, 13 articles describing Wii-related injuries were included reporting on 3 fractures, 6 nonosseous, 2 overuse injuries, and 2 rehabilitation programs using Wii for posttraumatic rehabilitation. Among the presented Wii-related injuries, only 12.5% were treated conservatively, whereas 87.5% underwent either surgical or interventional treatment. Because of the reported case, the literature search was limited to Wii-related injuries excluding other video games. Another limitation of this article lies in the fact that mainly case reports but no controlled trials exist on the topic. Assumingly, primarily the more severe injuries are reported in the literature with an unknown number of possibly minor injuries. Motion-controlled video games, such as Wii, are becoming increasingly popular as a recreational entertainment. Because of their wide acceptance and entertaining nature, they are also increasingly recognized as a tool in rehabilitation. However, although the activity is simulated, injuries are real. Our systematic review shows that Wii gaming can lead to severe injuries, sometimes with lasting limitations. PMID:25816033

  15. Arthroscopic preparation of the posterior and posteroinferior glenoid labrum.

    PubMed

    Provencher, Matthew T; Romeo, Anthony A; Solomon, Daniel J; Bach, Bernard R; Cole, Brian J

    2007-11-01

    Using an anterior portal for a labral elevator and shaver instrument, with the arthroscope in the anterosuperior portal, allows the posterior and posteroinferior chondrolabral junction to be safely prepared. PMID:18019981

  16. Bone Tunnel Diameter Measured with CT after Anterior Cruciate Ligament Reconstruction Using Double-Bundle Auto-Hamstring Tendons: Clinical Implications

    PubMed Central

    Yoon, Soo Jeong; Bae, So Young; Wang, Joon Ho

    2015-01-01

    Objective To evaluate the correlation between bone tunnel diameter after anterior cruciate ligament (ACL) reconstruction measured by computed tomography (CT) using multiplanar reconstruction (MPR) and stability or clinical scores. Materials and Methods Forty-seven patients (41 men and 6 women, mean age: 34 years) who had undergone ACL reconstruction with the double bundle technique using auto-hamstring graft and had subsequently received CT scans immediately after the surgery (T1: range, 1-4 days, mean, 2.5 days) and at a later time (T2: range, 297-644 days, mean, 410.4 days) were enrolled in this study. The diameter of each tunnel (two femoral and two tibial) at both T1 and T2 were independently measured using MPR technique by two radiologists. Stability and clinical scores were evaluated with a KT-2000 arthrometer, International Knee Documentation Committee objective scores, and the Lysholm score. Statistical analysis of the correlation between the diameter at T2 or the interval diameter change ratio ([T2 - T1] / T1) and clinical scores or stability was investigated. Results The tibial bone tunnels for the anteromedial bundles were significantly widened at T2 compared with T1 (observer 1, 0.578 mm to 0.698 mm, p value of < 0.001; observer 2, 0.581 mm to 0.707 mm, p value of < 0.001). There was no significant correlation between the diameter at T2 and stability or clinical scores and between the interval change ratio ([T2 - T1] / T1) and stability or clinical scores (corrected p values for all were 1.0). Intraobserver agreement for measurements was excellent (> 0.8) for both observers. Interobserver agreement for measurement was excellent (> 0.8) except for the most distal portion of the femoral bone tunnel for anterior medial bundle in immediate postoperative CT, which showed moderate agreement (concordance correlation coefficient = 0.6311). Conclusion Neither the diameter nor its change ratio during interval follow-up is correlated with stability or clinical scores. PMID:26576121

  17. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months

    PubMed Central

    Schulz, Arndt P; Lange, Vivien; Gille, Justus; Voigt, Christine; Fröhlich, Susanne; Stuhr, Markus; Jürgens, Christian

    2013-01-01

    Introduction Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24–36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. Materials and methods The study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15–58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3–38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Results Graft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5–10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17–100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2–7) compared to a mean value of 4.16 (2–7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65–100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair. Conclusion ACL reconstruction using a bone plug-free quadriceps tendon autograft achieved satisfactory results in a midterm review. PMID:24379730

  18. Safety and analgesic efficacy of intravenous dexmedetomidine in arthroscopic knee surgery

    PubMed Central

    Kundu, Riddhi; Dehran, Maya; Chandralekha; Trikha, Anjan; Nag, H. L.

    2015-01-01

    Context: Dexmedetomidine, a highly selective alpha-2 agonist has been used as an adjuvant analgesic in vascular, bariatric, and thoracic surgery. We assessed the efficacy of intravenous dexmedetomidine as an analgesic adjunct to local anesthetic infiltration for control of postoperative pain in arthroscopic knee surgery. Settings and Design: This was a randomized control study performed in a Tertiary Care Hospital. Materials and Methods: Forty-five adult patients scheduled for anterior/posterior cruciate ligament reconstruction were randomized into three groups. Group B (bupivacaine group) received bupivacaine intraarticularly and normal saline by the intravenous route. Group D (dexmedetomidine group) received Intravenous dexmedetomidine and normal saline intraarticularly. Group BD (bupivacaine + dexmedetomidine group) received a combination of intravenous dexmedetomidine and intraarticular bupivacaine. Patient's cardiorespiratory parameters, time to first rescue, total rescue analgesic consumption in first 24 h, visual analog scale for pain were assessed. Statistical Analysis: The data were analyzed using analysis of variance and Chi-square test. Results: The time to first request for rescue analgesia was significantly prolonged in Group D and Group BD patients (P < 0.05) compared to Group B. Total rescue analgesic consumption was least in Group BD. Group D and Group BD patients had lower heart rate and systolic and diastolic blood pressure values. Conclusion: Intravenous dexmedetomidine in combination with intraarticular bupivacaine decreased perioperative analgesic requirement in patients undergoing arthroscopic knee surgery. However, monitoring and vigilance are essential if dexmedetomidine is used as part of a multimodal analgesic regimen in view of its hemodynamic side effects. PMID:26712980

  19. Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft.

    PubMed

    Mei-Dan, Omer; Mann, Gideon; Steinbacher, Gilbert; Ballester, Soleda J; Cugat, Ramon Bertomeu; Alvarez, Pedro Diaz

    2008-01-01

    Septic arthritis following anterior cruciate ligament reconstruction is an uncommon but a serious complication resulting in six times greater hospital costs than that of uncomplicated ACL surgery and an inferior postoperative activity level. Promptly initiating a specific antibiotic therapy is the most critical treatment, followed by open or arthroscopic joint decompression, debridement and lavage. Staphylococcus lugdunensis is a coagulase-negative staphylococcus predominantly infecting the skin and soft tissue. The few reported cases of bone and joint infections by S. lugdunensis indicate that the clinical manifestations were severe, the diagnosis elusive, and the treatment difficult. If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism might be misidentified as Staphylococcus aureus. S. lugdunensis is more virulent than other coagulase-negative staphylococcus; in many clinical situations it behaves like S. aureus, further increasing the confusion and worsening the expected outcome. S. lugdunensis is known to cause infective endocarditis with a worse outcome, septicemia, deep tissue infection, vascular and joint prosthesis infection, osteomyelitis, discitis, breast abscess, urine tract infections, toxic shock and osteitis pubis. We present the first case report in the literature of septic arthritis with S. lugdunensis following arthroscopic ACL revision with bone-patellar-tendon-bone allograft. PMID:17684731

  20. Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

    PubMed Central

    de Fontenay, Benoît Pairot; Argaud, Sebastien; Blache, Yoann; Monteil, Karine

    2014-01-01

    Context: Asymmetries subsist after anterior cruciate ligament reconstruction (ACL-R), and it is unclear how lower limb motion is altered in the context of a dynamic movement. Objective: To highlight the alterations observed in the injured limb (IL) during the performance of a dynamic movement after ACL-R. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 11 men (age = 23.3 ± 3.8 years, mass = 81.2 ± 17.0 kg) who underwent ACL-R took part in this study 7.3 ± 1.1 months (range = 6–9 months) after surgery. Intervention(s): Kinematic and kinetic analyses of a single-legged squat jump were performed. The uninjured leg (UL) was used as the control variable. Main Outcome Measure(s): Kinematic and kinetic variables. Results: Jump height was 24% less for the IL than the UL (F1,9 = 23.3, P = .001), whereas the push-off phase duration was similar for both lower limbs (P = .96). Knee-joint extension (F1,9 = 11.4, P = .009), and ankle plantar flexion (F1,9 = 22.6, P = .001) were less at takeoff for the IL than the UL. The hip angle at takeoff was not different between lower limbs (P = .09). We found that total moment was 14% less (F1,9 = 11.1, P = .01) and total power was 35% less (F1,9 = 24.2, P = .001) for the IL than the UL. Maximal hip (P = .09) and knee (P = .21) power was not different between legs. The IL had 34% less maximal ankle power (F1,9 = 11.3, P = .009) and 31% less angular velocity of ankle plantar flexion (F1,9 = 17.8, P = .004) than the UL. Conclusions: At 7.3 months after ACL-R, motion alterations were present in the IL, leading to a decrease in dynamic movement performance. Enhancing the tools for assessing articular and muscular variables during a multijoint movement would help to individualize rehabilitation protocols after ACL-R. PMID:24840584

  1. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR

    PubMed Central

    Leal, Mariana Ferreira; Astur, Diego Costa; Debieux, Pedro; Arliani, Gustavo Gonçalves; Franciozi, Carlos Eduardo Silveira; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

    2015-01-01

    The anterior cruciate ligament (ACL) is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP) by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury) and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ?Ct method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1) injured ACL tears and controls, and (2) ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears. PMID:26192306

  2. Effects of Suture Choice on Biomechanics and Physeal Status After Bioenhanced Anterior Cruciate Ligament Repair in Skeletally Immature Patients: A Large-Animal Study

    PubMed Central

    Vavken, Patrick; Proffen, Benedikt; Peterson, Chris; Fleming, Braden C.; Machan, Jason T.; Murray, Martha M.

    2012-01-01

    Purpose The objective of this study was to assess the effect of absorbable or nonabsorbable sutures in bioenhanced anterior cruciate ligament (ACL) repair in a skeletally immature pig model on suture tunnel and growth plate healing and biomechanical outcomes. Methods Sixteen female skeletally immature Yorkshire pigs were randomly allocated to receive unilateral, bioenhanced ACL repair with an absorbable (Vicryl) or nonabsorbable (Ethibond) suture augmented by an extracellular matrix-based scaffold (MIACH). After 15 weeks of healing, micro–computed tomography was used to measure residual tunnel diameters and growth plate status, and biomechanical outcomes were assessed. Results At 15 weeks postoperatively, there was a significant difference in tunnel diameter with significantly larger diameters in the nonabsorbable suture group (4.4 ± 0.3 mm; mean ± SD) than in the absorbable group (1.8 ± 0.5 mm; P <.001). The growth plate showed a significantly greater affected area in the nonabsorbable group (15.2 ± 3.4 mm2) than in the absorbable group (2.7 ± 0.8 mm2, P < .001). There was no significant difference in the linear stiffness of the repairs (29.0 ± 14.8 N/mm for absorbable v 43.3 ± 28.3 N/mm for nonabsorbable sutures, P = .531), but load to failure was higher in the nonabsorbable suture group (211 ± 121.5 N) than in the absorbable suture group (173 ± 101.4 N, P =.002). There was no difference between the 2 groups in anteroposterior laxity at 30° (P = .5117), 60° (P = .3150), and 90° (P = .4297) of knee flexion. Conclusions The use of absorbable sutures for ACL repair resulted in decreased physeal plate damage after 15 weeks of healing; however, use of nonabsorbable sutures resulted in 20% stronger repairs. Clinical Relevance Choice of suture type for ACL repair or repair of tibial avulsion fractures may depend on patient skeletal age and size, with absorbable sutures preferred in very young, small patients at higher risk with physeal damage and nonabsorbable sutures preferred in larger, prepubescent patients who may place higher loads on the repair. PMID:23200845

  3. Knee Arthroscopy

    MedlinePLUS

    ... an EKG (electrocardiogram). Surgery Arthroscopic picture of torn anterior cruciate ligament [yellow star]. Almost all arthroscopic knee surgery is ... of torn meniscal cartilage • Reconstruction of a torn anterior cruciate ligament • Trimming of torn pieces of articular cartilage • Removal ...

  4. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePLUS

    ... playing sports? Teens who play contact sports (like football) or sports that feature swift, abrupt movements such ... the things you love — like running or playing football, field hockey, or softball — can be frustrating. Recovering ...

  5. Anterior cruciate ligament (ACL) injury

    MedlinePLUS

    ... side of your knee, such as during a football tackle Overextend the knee joint Quickly stop moving ... running, landing from a jump, or turning Basketball, football, soccer, and skiing are common sports linked to ...

  6. Arthroscopic Transosseous Bony Bankart Repair

    PubMed Central

    Driscoll, Matthew D.; Burns, Joseph P.; Snyder, Stephen J.

    2015-01-01

    Restoration of glenoid bony integrity is critical to minimizing the risk of recurrence and re-creating normal kinematics in the setting of anterior glenohumeral instability. We present an arthroscopic suture anchor–based technique for treating large bony Bankart fractures in which the fragment is secured to the intact glenoid using mattress sutures placed through the bony fragment and augmented with soft-tissue repair proximal and distal to the bony lesion. This straightforward technique has led to excellent fragment reduction and good outcomes in our experience. PMID:25973373

  7. Why arthroscopic partial meniscectomy?

    PubMed

    Lyu, Shaw-Ruey

    2015-09-01

    "Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear" published in the New England Journal of Medicine on December 26, 2013 draws the conclusion that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. This result argues against the current practice of performing arthroscopic partial meniscectomy (APM) in patients with a degenerative meniscal tear. Since the number of APM performed has been increasing, the information provided by this study should lead to a change in clinical care of patients with a degenerative meniscus tear. PMID:26488013

  8. Why arthroscopic partial meniscectomy?

    PubMed Central

    2015-01-01

    Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear” published in the New England Journal of Medicine on December 26, 2013 draws the conclusion that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. This result argues against the current practice of performing arthroscopic partial meniscectomy (APM) in patients with a degenerative meniscal tear. Since the number of APM performed has been increasing, the information provided by this study should lead to a change in clinical care of patients with a degenerative meniscus tear. PMID:26488013

  9. A canine hybrid double-bundle model for study of arthroscopic ACL reconstruction.

    PubMed

    Cook, James L; Smith, Patrick A; Stannard, James P; Pfeiffer, Ferris M; Kuroki, Keiichi; Bozynski, Chantelle C; Cook, Cristi R

    2015-08-01

    Development and validation of a large animal model for pre-clinical studies of intra-articular anterior cruciate ligament (ACL) reconstruction that addresses current limitations is highly desirable. The objective of the present study was to investigate a translational canine model for ACL reconstruction. With institutional approval, adult research hounds underwent arthroscopic debridement of the anteromedial bundle (AMB) of the ACL, and then either received a tendon autograft for "hybrid double-bundle" ACL reconstruction (n?=?12) or no graft to remain ACL/AMB-deficient (n?=?6). Contralateral knees were used as non-operated controls (n?=?18) and matched canine cadaveric knees were used as biomechanical controls (n?=?6). Dogs were assessed using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for pre-clinical animal models. The data suggest that this canine model was able to overcome the major limitations of large animal models used for translational research in ACL reconstruction and closely follow clinical aspects of human ACL reconstruction. The "hybrid double-bundle" ACL reconstruction allowed for sustained knee function without the development of osteoarthritis and for significantly improved functional, diagnostic imaging, gross, biomechanical, and histologic outcomes in grafted knees compared to ACL/AMB-deficient knees. PMID:25763560

  10. Comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction after a minimum of 3-year follow-up: a meta-analysis of randomized controlled trials

    PubMed Central

    Chen, Gang; Wang, Shouguo

    2015-01-01

    Both single-bundle (SB) and double-bundle (DB) procedures have been widely used in the treatment of anterior cruciate ligament (ACL) rupture; however, the optimal repair strategy remains considerably controversial. In this meta-analysis of published studies, we compared the results of these two techniques. After systematic review of electronic databases and websites, a total of 8 RCTs reporting data on 941 subjects were included. The objective and subjective functional recovery outcomes were meta-analyzed. The methodological quality was evaluated using the CBRG scale. The overall pooled data showed superiority in rotational stability, the degree of osteoarthritis (OA) changes, and subjective function score postoperatively in patients managed with DB compared with the SB procedure (pivot shift test, P = 0.02; degree of OA, P = 0.02; Lysholm score, P = 0.04; and Tegner scale, P = 0.002, respectively). However, subgroup analysis suggested no difference between the treatment procedures at long-term follow-up. This meta-analysis demonstrated that the DB technique could result in better rotational stability and higher subjective function score and was effective in preventing OA compared to SB in the mid-term treatment of the injured ACL. Further studies with better design involving larger sample sizes and longer-term follow-up are required. PMID:26628943

  11. Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1-year follow-up study using peripheral quantitative computed tomography.

    PubMed

    Mündermann, Annegret; Payer, Nina; Felmet, Gernot; Riehle, Hartmut

    2015-12-01

    The purpose of this study was to quantify changes in volumetric bone mineral density (vBMD) in the tibial plateau of the operated and contralateral leg measured using peripheral quantitative computed tomography (pQCT) before and 3, 6, and 12 months after anterior cruciate ligament (ACL) reconstruction. The ACL was reconstructed with a hamstring tendon autograft using press-fit fixation. pQCT measurements of the proximal tibia were obtained in 61 patients after ACL reconstruction, and total, cortical, and trabecular vBMD were calculated. vBMD in the operated leg decreased from baseline to 3 months (-12% [total], -11% [cortical], and -12.6% [trabecular]; p?

  12. Arthroscopic Anatomy of the Subdeltoid Space

    PubMed Central

    J. Salata, Michael; J. Nho, Shane; Chahal, Jaskarndip; Van Thiel, Geoffrey; Ghodadra, Neil; Dwyer, Tim; A. Romeo, Anthony

    2013-01-01

    From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears. PMID:24191185

  13. Treatment of Type 3 Arthrofibrosis Following Arthroscopic Reconstruction of ACL and Posterolateral Corner Injury with Tibia Plateau Fracture in a Professional Dancer

    PubMed Central

    Aksu, Neslihan; Abay, Burak; Soydan, Ramazan; Atansay, Vefa

    2014-01-01

    Objectives: Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy. Methods: A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia. Results: At the 3 month- follow-up, the patient achieved full symmetric restoration of motion and he had returned to full daily activities. The Tegner Lysholm score was evaluated as 94 (excellent) postoperatively. Functional examination of the left knee reveled 155 of flexion, and full knee extension. The complaint of instability was disappeared. At 9 month-follow-up, clinical findings were unremarkable, with no sign of re-rupture and arthrofibrosis and he returned to his professional dance career. Conclusion: In the literature there is not any consensus regarding the management and rehabilitation intervention for arthrofibrosis in young athletes or professional dancers. The best treatment method is preventing the arthrofibrosis once it has occurred with surgical lysis and aggressive physical therapy. The combined surgical treatment and physiotherapy described in this case report may assist clinicians in the treatment of arthrofibrosis after arthroscopic reconstruction of ACL and PLC injury.

  14. Arthroscopic Surgical Techniques for the Management of Proximal Biceps Injuries.

    PubMed

    Werner, Brian C; Holzgrefe, Russell E; Brockmeier, Stephen F

    2016-01-01

    Current arthroscopic surgical techniques for the management of proximal biceps tendon disorders encompass 3 commonly advocated procedures: proximal biceps anchor reattachment (superior labrum anterior to posterior or SLAP repair), biceps tenotomy, and arthroscopic biceps tenodesis. The indications for each procedure vary based on injury pattern, symptomatic presentation, concomitant pathologic abnormality, and most notably, patient factors, such as age, functional demand, and specific sport or activity participation. Outcomes after SLAP repair are generally favorable, although recent studies have found biceps tenodesis to be the preferred treatment for certain patient populations. PMID:26614472

  15. Arthroscopic Correction of a Supracondylar Malunion in a Child

    PubMed Central

    Koehler, Steven M.; Sakamoto, Sara; Abernathie, Brenon L.; Hausman, Michael R.

    2015-01-01

    Malunions are a well-recognized complication of pediatric supracondylar humeral fractures. Results of corrective osteotomies vary, and complication rates have been reported to be as high as 40%. Considering the high rate of complications for malunion correction, we investigated the feasibility of arthroscopy. We present a technique for arthroscopic supracondylar osteotomy and percutaneous pinning. There are many advantages of an arthroscopic approach to malunion correction, including extension-type deformity correction, safe access to the anterior humerus, and minimal dissection and scarring; any intracapsular contracture can be addressed as well. Elbow arthroscopy appears to be a viable option in the pediatric orthopaedic surgeon's armamentarium. PMID:26258033

  16. Detached Anterior Horn of the Medial Meniscus Mimicking a Parameniscal Cyst

    PubMed Central

    Fukuta, Shoji; Tsutsui, Takahiko; Matsuura, Tetsuya; Suzue, Naoto; Hamada, Daisuke; Goto, Tomohiro; Sairyo, Koichi

    2015-01-01

    We report a case of a detached anterior horn of the medial meniscus with anterior knee pain. Preoperative magnetic resonance images of the knee were initially interpreted as a parameniscal cyst. Arthroscopic examination revealed subluxation of the anterior horn of the medial meniscus due to detachment from its anterior tibial insertion. Arthroscopic fixation with a suture anchor was successful and the cystic lesion was no longer visible on postoperative images. PMID:26550510

  17. Arthroscopic technique of interposition arthroplasty of the glenohumeral joint.

    PubMed

    Bhatia, Deepak N; van Rooyen, Karin S; du Toit, Donald F; de Beer, Joe F

    2006-05-01

    Arthroscopic glenohumeral interposition arthroplasty is performed with the patient placed in the lateral decubitus position. Standard posterior, anterior, and anterosuperior portals are created, a routine diagnostic arthroscopy is performed, and the joint is débrided with the use of an arthroscopic shaver. An arthroscopic burr is used to resect prominent osteophytes, to alter the version of the glenoid if necessary, and to create microfractures on the glenoid surface. Next, 3 absorbable sutures are passed percutaneously with a 30 degrees angled suture grasper from 3 different sites posteriorly through the posterior capsular-labral tissue and into the anterior portal cannula, where they are isolated by means of the suture saver kit. The prepared interposition membrane/tissue (GRAFTJACKET Regenerative Tissue Matrix, Wright Medical Technology, Inc., Arlington, TN) is tagged with the 3 sutures in the anterior cannula before it is introduced into the joint. Three additional sutures are attached to the membrane anteriorly at 1, 3, and 5 o'clock positions and are isolated with suture savers. The membrane is next introduced into the joint through the anterior cannula and is aligned with the glenoid rim. The anterior sutures are rerouted through the anterior capsular-labral tissue with a 70 degrees angled suture grasper, and they are retrieved through the anterior cannula. Intra-articular nonsliding knots are used anteriorly to anchor the interposition tissue to the anterior glenoid labrum and capsule. The posterior sutures are knotted intra-articularly, or they may be tied extra-articularly; the proximal and distal posterior sutures are retrieved subcutaneously out through the skin tract of the posterior portal and are knotted with the suture present in this portal, with the use of nonsliding knots. Stability of the interposition tissue is assessed by movement of the glenohumeral joint through its entire range of motion. The postoperative protocol consists of early passive exercises, active exercises after 3 weeks, and muscle-strengthening exercises after 6 weeks. PMID:16651174

  18. Modified arthroscopic Brostrom procedure.

    PubMed

    Lui, Tun Hing

    2015-09-01

    The open modified Brostrom anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. However, there is high incidence of intra-articular pathologies associated with chronic lateral ankle instability which may not be addressed by an isolated open Brostrom procedure. Arthroscopic Brostrom procedure with suture anchor has been described for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. However, the complication rates seemed to be higher than open Brostrom procedure. Modification of the arthroscopic Brostrom procedure with the use of bone tunnel may reduce the risk of certain complications. PMID:26235865

  19. Arthroscopic evaluation and management after repeated luxatio erecta of the glenohumeral joint.

    PubMed

    Tracy, Sean C; Myer, Jonathan J

    2009-05-01

    Luxatio erecta, inferior dislocation of the glenohumeral joint, is a relatively rare type of glenohumeral dislocation, accounting for <0.5% of all shoulder dislocations. It has been well described in terms of presentation and conservative management. Arthroscopic findings after the more commonly found anteroinferior glenohumeral dislocation have also been described. However, we know of only 1 case report that details the arthroscopic findings and open surgical management in a patient who sustained a single episode of luxatio erecta. Additionally, we were unable to find any reports in the literature of the arthroscopic management of this type of dislocation. We present the arthroscopic findings and arthroscopic management of an 18-year-old male college football player who reported 7 episodes of left shoulder luxatio erecta. Arthroscopic evaluation revealed an extensive anterior capsulolabral injury as well as a superior labrum anteroposterior (SLAP) tear. Additionally, there were extensive articular cartilage changes of the anterosuperior glenoid, a posterior Hill-Sachs lesion, and an anterosuperior humeral head cartilage indentation. The anterior capsulolabral injury and the SLAP lesion were fixed arthroscopically with suture anchors. The remainder of the lesions were debrided. The patient was able to return to college-level football and reported no further episodes of instability, pain, or stiffness at 3-year follow-up. PMID:19472949

  20. A new "double-pulley" dual-row technique for arthroscopic fixation of bony Bankart lesion.

    PubMed

    Zhang, Jin; Jiang, Chunyan

    2011-09-01

    The double-row technique is a new concept for arthroscopic treatment of bony Bankart lesion in shoulder instability. It presents a new and reproducible technique for arthroscopic fixation of bony Bankart fragments with suture anchors. This technique creates double-mattress sutures which compress the fragment against its bone bed and restores better bony anatomy of the anterior glenoid rim with stable and non-tilting fixation that may improve healing. PMID:21290115

  1. Arthroscopic Anatomic Glenoid Reconstruction Without Subscapularis Split

    PubMed Central

    Wong, Ivan H.; Urquhart, Nathan

    2015-01-01

    The role of bone loss from the anterior glenoid in recurrent shoulder instability has been well established. We present a completely arthroscopic technique for reconstructing the anterior glenoid with distal tibial allograft and without a subscapularis split. We perform the arthroscopy in the lateral position. We measure and size an allograft distal tibial graft and place it arthroscopically. We use an inside-out medial portal to introduce the graft into the shoulder, passing it through the rotator interval and above the subscapularis. A double-cannula system is used to pass the graft, which is temporarily fixed with K-wires and held in place with cannulated screws. We then perform a Bankart-like repair of the soft tissues to balance the shoulder and augment our repair. Our technique is not only anatomic in the re-creation of the glenoid surface but also anatomic in the preservation of the coracoid and subscapularis tendon and repair of the capsulolabral complex. PMID:26697303

  2. Quadriceps Strength, Muscle Activation Failure, and Patient-Reported Function at the Time of Return to Activity in Patients Following Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study.

    PubMed

    Lepley, Lindsey K; Palmieri-Smith, Riann M

    2015-12-01

    Study Design Cross-sectional. Objectives To determine if quadriceps activation failure (QAF) moderates the relationship between quadriceps strength and physical function in individuals following anterior cruciate ligament (ACL) reconstruction. Background Quadriceps activation failure may impair the recovery of physical function after ACL reconstruction, given that QAF reduces strength and strength is related to physical function. Evidence of this relationship has been found in individuals with knee osteoarthritis, wherein patients with lower strength and greater QAF had lower levels of physical function. Methods Participants consisted of 52 individuals who were cleared for return to activity at an average ± SD of 7.4 ± 1.2 months post-ACL reconstruction. Quadriceps activation failure was assessed using the superimposed burst technique, and quadriceps strength was assessed using concentric isokinetic contractions (Newton meters per kilogram). Physical function was quantified using a combined variable of a physical measure (single-leg hop for distance) and a self-reported function measure (International Knee Documentation Committee [IKDC] Subjective Knee Evaluation Form), calculated using a principal-component analysis. Simple correlations were then performed to determine the order in which variables were entered into the regression model to evaluate if QAF moderates the relationship between quadriceps strength and physical function. Results The combination of quadriceps strength and the interaction of strength by QAF predicted 30% of the variance in physical function (R(2) = 0.30, P<.001; principal-component analysis, -0.61strength + 0.02interaction -1.896); however, the interaction of strength by QAF only accounted for 7% of the capabilities of the model (P = .023). Conclusion Physical function is largely influenced by the recovery of quadriceps strength and minimally attenuated by QAF. These data suggest that QAF may affect individuals post-ACL reconstruction differently, and to a lesser extent, than individuals with knee osteoarthritis. This trial was prospectively registered in a public registry (NCT01555567). J Orthop Sports Phys Ther 2015;45(12):1017-1025. Epub 15 Oct 2015. doi:10.2519/jospt.2015.5753. PMID:26471854

  3. Self-reported Knee Function Can Identify Athletes Who Fail Return to Activity Criteria up to 1 Year after Anterior Cruciate Ligament Reconstruction. A Delaware-Oslo ACL Cohort Study

    PubMed Central

    Logerstedt, David; Stasi, Stephanie Di; Grindem, Hege; Lynch, Andrew; Eitzen, Ingrid; Engebretsen, Lars; Risberg, May Arna; Axe, Michael J; Snyder-Mackler, Lynn

    2014-01-01

    STUDY DESIGN Cohort study, cross-sectional. OBJECTIVES To determine if self-reported knee function assessed with the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC2000) could discriminate between successful and non-successful performance on return to activity criteria (RTAC) tests after anterior cruciate ligament (ACL) reconstruction. BACKGROUND Rehabilitation specialists are challenged in selecting appropriate performance-based and patient-reported tests that can detect side-to-side asymmetries, assess global knee function, and determine a participant's readiness to return to activity after ACL reconstruction. A simple tool or questionnaire that could identify athletes with neuromuscular impairments or activity limitations could provide rehabilitation specialists crucial data pertinent to their current knee function and their readiness to return to higher level activities. METHODS One hundred fifty-eight Level I/II athletes 6 months after ACL reconstruction and 141 athletes 12 months after ACL reconstruction completed a functional test battery to determine readiness to return to activity and the IKDC2000 to determine self-reported knee function. For each athlete, status on return to activity tests criteria was dichotomized as “Passed” or ”Failed” and status on the IKDC2000 scores was dichotomized as being “within” or “below age- and sex-matched normal ranges”. Comparisons were made between status on RTAC and IKDC2000 using Chi-square tests. Accuracy statistics were also calculated. RESULTS Six months after ACL reconstruction, 112 athletes (70.9%) failed RTAC and 76 (48.1%) were classified as having self-reported knee function below normal ranges. Among the 76 participants with IKDC2000 scores below normal ranges, 69 (90.8%) failed RTAC test battery (P<.001). However, among the 82 participants whose IKDC2000 scores were within normal limits at 6 months, only 39 (47.6%) passed RTAC test battery (P=.74). Twelve months after ACL reconstruction, 67 athletes (47.5%) failed RTAC and 31 (78.0%) had knee function below normal ranges. Among the 31 participants with IKDC2000 scores below normal ranges, 25 (80.6%) failed RTAC test battery (P<.001). However, among the 110 participants whose IKDC2000 scores were within normal limits at 12 months, only 68 (61.8%) passed RTAC test battery (P=.017). CONCLUSION The IKDC2000 may be a clinically relevant tool to determine the timeliness or necessity of RTAC testing. For scores obtained 6 and 12 months after ACL reconstruction, low IKDC2000 scores were reasonably indicative of failure on RTAC test battery, whereas normal IKDC2000 scores were not predictive of passing scores on the RTAC test battery. PMID:25347228

  4. Arthroscopic acromioplasty. Current status.

    PubMed

    Altchek, D W; Carson, E W

    1997-04-01

    Impingment is a chronic syndrome characterized by microtrauma, which causes progressive injury to the rotator cuff tendon. In recent years, arthro- scopic subacromial decompression/acromioplasty has been frequently used for the treatment of impingement syndrome and is quickly becoming the preferred surgical treatment when conservative modalities fail. Arthroscopic acromioplasty offers many benefits over open acromioplasty, including better cosmesis, lessened preoperative morbidity, a more complete intraoperative examination, and a hastened, early rehabilitation program. PMID:9113712

  5. Arthroscopic tennis elbow release.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2015-01-01

    Lateral epicondylitis, originally referred to as tennis elbow, affects between 1% and 3% of the population and is usually found in patients aged 35 to 50 years. Although it was initially thought that lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon and in any of the associated structures. Most cases of lateral epicondylitis respond to appropriate nonsurgical treatment protocols, which include medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal or ultrasound ablation devices. However, when these protocols are unsuccessful, surgical measures may be appropriate and have a high rate of success. The results of arthroscopic surgical procedures have documented satisfactory results, with improvement rates reported between 91% and 97.7%. Recent advances in arthroscopic repair and plication of these lesions, along with recognizing the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide excellent results. PMID:25745908

  6. Arthroscopic Bony Bankart Fixation Using a Modified Sugaya Technique

    PubMed Central

    Gupta, Anil K.; McCormick, Frank M.; Abrams, Geoffrey D.; Harris, Joshua D.; Bach, Bernard R.; Romeo, Anthony A.; Verma, Nikhil N.

    2013-01-01

    Arthroscopic fixation of bony Bankart lesions in the setting of anterior shoulder instability has had successful long-term results. Key factors such as patient positioning, portal placement, visualization, mobilization of bony/soft tissues, and anatomic reduction and fixation are crucial to yield such results. We present a modified Sugaya technique that is reproducible and based on such key principles. This technique facilitates ease of anchor and suture placement to allow for anatomic reduction and fixation. PMID:24265994

  7. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Frank, Rachel M.; Pulido, Luis

    2015-01-01

    Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI. PMID:26697431

  8. Anterior cruciate ligament (ACL) injury - aftercare

    MedlinePLUS

    ... of Physical Medicine and Rehabilitation . 2nd ed. St. Louis, MO: Saunders Elsevier; 2008:chap 55. Honkamp NJ, ... DeLee & Drez's Orthopaedic Sports Medicine . 3rd ed. St. Louis, MO: Saunders Elsevier; 2009:chap 23. Miller III ...

  9. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

    Strickland, Sabrina M; MacGillivray, John D; Warren, Russell F

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used. PMID:12735200

  10. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction. PMID:17920955

  11. Graft selection in anterior cruciate ligament reconstruction.

    PubMed

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

    Selecting the appropriate graft for ACL reconstruction depends on numerous factors including surgeon philosophy and experience, tissue availability (affected by anatomical anomalies or prior injury or surgery), and patient activity level and desires. Although the patella tendon autograft has the widest experience in the literature, and is probably the most commonly used graft source, this must be tempered with the higher reported incidences of potential morbidity and pitfalls associated with its use. The hamstring tendons are gaining increasing popularity, mostly due to reduced harvest morbidity and improved soft tissue fixation techniques, and many recent studies in the literature report equal results to BTB ACL reconstruction with respect to functional outcome and patient satisfaction. On the other hand, many of these studies report higher degrees of instrument (KT-100) tested laxity for hamstring reconstruction, and some have reported lower returns to preinjury levels of activity. One question that remains to be addressed is how closely objectively measured laxity tests correlate with subjectively assessed outcomes and ability to return to high levels of competitive sports. Allograft use, which decreased in popularity during the 1990s, appears to be undergoing a resurgence, with better sterilization processes and new graft sources (tibialis tendons), leading to increased availability and improved fixation techniques. The benefits of decreased surgical morbidity and easier rehabilitation must be weighed against the potential for greater failure of biologic incorporation, infection, and possibly slower return to activities. In our practice, for high-demand individuals (those playing cutting, pivoting, or jumping sports and skiing) BTB tends to be the graft of choice. For lower demand or older individuals, hamstring reconstructions will be performed. Allograft tissue will be used in older individuals (generally over 45 years old), those with signs of arthritis (and compelling evidence of instability), or those individuals who understand the pros and cons of allograft use fully and do not want their own tissue used. PMID:12528909

  12. A secure arthroscopic knot.

    PubMed

    Delimar, D

    1996-06-01

    The proposed arthroscopic knot tying technique procedure is simple, easy to master, time saving, and the knot formed is not bulky. The initial tie loop holding capacity securely overcomes tension force between structures repaired. The completed know, secured with additional two throw square knot or with a three half-hitches incorporating the post switching and/or loop direction reversal, will fail by breakage rather than by slippage (for the most commercially available 0, 2/0, 3/0, absorbable and nonabsorbable, monofilament and braided sutures. PMID:8783832

  13. Arthroscopic Repair of a Posterior Bony Humeral Avulsion of the Glenohumeral Ligament With Associated Teres Minor Avulsion

    PubMed Central

    Smith, Patrick A.; Nuelle, Clayton W.; Bradley, James P.

    2014-01-01

    Humeral avulsion of the inferior glenohumeral ligament (HAGL) has recently gained more recognition as a cause of shoulder instability. Posterior HAGL lesions, being much more infrequent than anterior disruptions, have only recently been documented as a notable cause of posterior instability. We detail the treatment of a previously unreported case of a posterior HAGL variant lesion consisting of a bony avulsion with involvement of the teres minor tendon. Arthroscopic fixation was facilitated by use of a “sheathless” arthroscopic approach with a 70° arthroscope and suture anchor. PMID:24749048

  14. Contralateral Cruciate Survival in Dogs with Unilateral Non-Contact Cranial Cruciate Ligament Rupture

    PubMed Central

    Muir, Peter; Schwartz, Zeev; Malek, Sarah; Kreines, Abigail; Cabrera, Sady Y.; Buote, Nicole J.; Bleedorn, Jason A.; Schaefer, Susan L.; Holzman, Gerianne; Hao, Zhengling

    2011-01-01

    Background Non-contact cranial cruciate ligament rupture (CrCLR) is an important cause of lameness in client-owned dogs and typically occurs without obvious injury. There is a high incidence of bilateral rupture at presentation or subsequent contralateral rupture in affected dogs. Although stifle synovitis increases risk of contralateral CrCLR, relatively little is known about risk factors for subsequent contralateral rupture, or whether therapeutic intervention may modify this risk. Methodology/Principal Findings We conducted a longitudinal study examining survival of the contralateral CrCL in client-owned dogs with unilateral CrCLR in a large baseline control population (n?=?380), and a group of dogs that received disease-modifying therapy with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline (n?=?16), and were followed for one year. Follow-up in treated dogs included analysis of mobility, radiographic evaluation of stifle effusion and arthritis, and quantification of biomarkers of synovial inflammation. We found that median survival of the contralateral CrCL was 947 days. Increasing tibial plateau angle decreased contralateral ligament survival, whereas increasing age at diagnosis increased survival. Contralateral ligament survival was reduced in neutered dogs. Our disease-modifying therapy did not significantly influence contralateral ligament survival. Correlative analysis of clinical and biomarker variables with development of subsequent contralateral rupture revealed few significant results. However, increased expression of T lymphocyte-associated genes in the index unstable stifle at diagnosis was significantly related to development of subsequent non-contact contralateral CrCLR. Conclusion Subsequent contralateral CrCLR is common in client-owned dogs, with a median ligament survival time of 947 days. In this naturally occurring model of non-contact cruciate ligament rupture, cranial tibial translation is preceded by development of synovial inflammation. However, treatment with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline does not significantly influence contralateral CrCL survival. PMID:21998650

  15. Posterior cruciate ligament (PCL) injury

    MedlinePLUS

    Cruciate ligament injury - posterior; PCL injury; Knee injury - posterior cruciate ligament (PCL); Hyperextended knee ... signs of PCL injury. This includes moving the knee joint in various ways. Your doctor may also ...

  16. [A man with a painful knee with restricted flexion].

    PubMed

    Valkering, Lucia J J; Zengerink, Maartje; van Kampen, Albert

    2015-01-01

    A 39-year-old man presented with knee pain and limited knee flexion. MRI showed a mucoid degeneration of the anterior cruciate ligament (celery stalk sign). This rare condition can be treated with arthroscopic debridement with volume reduction of the anterior cruciate ligament. In severe cases, anterior cruciate ligament resection could be considered. PMID:26395568

  17. Lateral Decubitus All-Arthroscopic Latarjet Procedure for Treatment of Shoulder Instability

    PubMed Central

    Lewington, Matthew R.; Urquhart, Nathan; Wong, Ivan H.

    2015-01-01

    Shoulder instability can be a challenging condition to treat when it becomes refractory to soft-tissue procedures or when bone loss exceeds 25% to 27% of the glenoid. The Bristow-Latarjet procedure has been developed and popularized to deal with these concerns. Traditionally, the procedure has been performed as an open approach; however, this has been recently supplanted by novel arthroscopic techniques. We present a technique for the procedure performed with the patient in a semi-lateral decubitus position that assists with optimal graft placement on the native glenoid. We use the cannulated Bristow-Latarjet Instability Shoulder System (DePuy Mitek, Raynham, MA). After a diagnostic arthroscopic evaluation, we use multiple arthroscopic anterior portals to debride the rim of the glenoid. The coracoid is prepared and taken down arthroscopically, and the cannulated guide is attached and advanced through an arthroscopically created subscapularis split. With the shoulder held in a reduced position, we are then able to drill and anchor the graft to the native glenoid. The patient is able to begin gentle range-of-motion exercises immediately postoperatively. PMID:26258032

  18. Fiber-optics couple arthroscope to TV

    NASA Technical Reports Server (NTRS)

    Franke, J. M.; Rhodes, D. B.

    1981-01-01

    Convenient, hand-held coupler images output of arthroscope onto coherent fiber bundle. Arthroscope allows surgeons to examine internal organs through any small opening in body. Coupler is also used for engine inspection, instrument repair, and around-corner visual inspection. Image from arthroscope travels along flexible bundle and appears at other cable end where it is recollimated by lens. Image is read from lens or projected on color TV camera.

  19. Thumb Carpometacarpal Ligaments Inside and Out: A Comparative Study of Arthroscopic and Gross Anatomy from the Robert A. Chase Hand and Upper Limb Center at Stanford University

    PubMed Central

    Zhang, Andrew Y.; Van Nortwick, Sarah; Hagert, Elisabet; Ladd, Amy L.

    2013-01-01

    Purpose?We propose to identify and correlate arthroscopic internal ligaments with external ligaments, providing an accurate roadmap for arthroscopic ligament and joint anatomy. Ligamentous laxity is considered an important risk factor in developing the common basilar arthritis of the thumb. Controversy exists as to the precise ligamentous anatomy of the thumb carpometacarpal (CMC) joint (CMC-I); description of the internal arthroscopic anatomy is limited. Methods?We performed CMC-I joint arthroscopy using the 1-Ulnar (1U) and thenar portals in five cadavers, seeking to identify the following seven ligaments arthroscopically: the superficial anterior oblique ligament (sAOL), deep anterior oblique ligament (dAOL), ulnar collateral ligament (UCL), dorsal trapeziometacarpal ligament (DTM-1), posterior oblique ligament (POL), dorsal central ligament (DCL), and dorsal radial ligament (DRL). After grading articular changes of the trapezium, we passed Kirschner wires (K-wires) (0.028) outside-in to mark the arthroscopic insertion of each ligament on the trapezium. Gross dissection was performed to confirm the wire placement; the anatomic identity and position of joint stabilizing ligaments, and the location of frequently used portals. Results?The volar ligaments—the sAOL, dAOL, and UCL—were highly variable in their arthroscopic appearance and precise location. The sAOL is a thin veil of membranous tissue that variably drapes across the anterior joint capsule. The reported dAOL and UCL, in our study, correlated to a thickened portion of this veil around the volar beak and was not consistently identified with gross dissection. In contrast, the arthroscopic appearance and location of the dorsal ligaments—DTM-I, POL, DCL, and DRL—were consistent in all specimens. Conclusion?Our study further defines and correlates the arthroscopic and external ligamentous anatomy of the CMC-I joint. PMID:24436790

  20. Anatomical popliteofibular ligament reconstruction of the knee joints: an all-arthroscopic technique.

    PubMed

    Song, Guan-Yang; Zhang, Hui; Zhang, Jin; Li, Yue; Feng, Hua

    2015-10-01

    Injuries to the posterolateral corner of the knee present with variable injury patterns that have produced a number of reconstructive procedures in the literature. The present paper describes an all-arthroscopic technique that anatomically reconstructs the popliteofibular ligament (PFL) using either a semitendinosus autograft or an anterior tibialis allograft. During the surgery, the fibular insertion site as well as the distal portion of PFL is feasible to be identified under arthroscopy without any additional skin incision. Level of evidence V. PMID:25666840

  1. Augmented Virtuality for Arthroscopic Knee Surgery

    E-print Network

    Stewart, James

    Augmented Virtuality for Arthroscopic Knee Surgery John M. Li1 , Davide D. Bardana2 , A. James residents. 1 Introduction Arthroscopic knee surgery is a minimally invasive procedure in which the surgeon open surgery. However, navigating within the joint is challenging because the camera image

  2. Semimembranosus tendon avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament tear and capsular rupture.

    PubMed

    Khoshnoodi, Pooria; Tehranzadeh, Arash D; Dunn, James M; Tehranzadeh, Jamshid

    2014-02-01

    Semimembranosus tendon avulsion fractures are an uncommon occurrence and are often associated with anterior cruciate ligament (ACL) and medial meniscus tears. We present the imaging features of an unusual case of semimembranosus avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament (PCL) tear, medial meniscus tear, and capsular rupture in a 26-year-old man with a football injury. PMID:24026070

  3. Arthroscopically assisted percutaneous fixation and bone grafting of a glenoid fossa fracture nonunion.

    PubMed

    Sears, Benjamin W; Lazarus, Mark D

    2012-08-01

    Arthroscopy is commonly used for evaluating intra-articular fracture patterns and assessing postfixation reduction; however, the use of arthroscopy for the definitive treatment of articular fracture nonunion has not been reported. This article describes a case of symptomatic glenoid fossa fracture nonunion that was successfully treated with arthroscopically assisted percutaneous screw fixation and bone grafting. A 48-year-old laborer sustained a glenoid fossa fracture following a fall from a height. An initial period of nonoperative management was attempted; however, the patient reported continued shoulder pain during his rehabilitation course. Imaging 5 months after injury showed no osseous union at the fracture. Using an arthroscopically assisted technique, percutaneous fixation and bone grafting of the nonunion with cancellous allograft was performed. Postoperatively, the patient progressed through a structured therapy program, and his pain improved. A computed tomography scan 4 months postoperatively showed osseous union at the fracture site. To the authors' knowledge, this is the first report in the literature of definitive arthroscopically assisted bone grafting and percutaneous fixation of a diarthrodial joint nonunion. Advantages of arthroscopic fixation of glenoid fossa fracture nonunion include avoiding potential axillary nerve injury and preserving the native subscapularis insertion, which may be important if subsequent procedures require access to the anterior access to the joint. PMID:22868621

  4. Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty

    E-print Network

    Delp, Scott

    the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translationPosterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty Melinda J. Cromie,1,2 Robert A. Siston,1,2,3,4 Nicholas J. Giori,2,5 Scott L

  5. The pathoanatomy and arthroscopic management of femoroacetabular impingement

    PubMed Central

    Tibor, L. M.; Leunig, M.

    2012-01-01

    Femoroacetabular impingement (FAI) causes pain and chondrolabral damage via mechanical overload during movement of the hip. It is caused by many different types of pathoanatomy, including the cam ‘bump’, decreased head–neck offset, acetabular retroversion, global acetabular overcoverage, prominent anterior–inferior iliac spine, slipped capital femoral epiphysis, and the sequelae of childhood Perthes’ disease. Both evolutionary and developmental factors may cause FAI. Prevalence studies show that anatomic variations that cause FAI are common in the asymptomatic population. Young athletes may be predisposed to FAI because of the stress on the physis during development. Other factors, including the soft tissues, may also influence symptoms and chondrolabral damage. FAI and the resultant chondrolabral pathology are often treated arthroscopically. Although the results are favourable, morphologies can be complex, patient expectations are high and the surgery is challenging. The long-term outcomes of hip arthroscopy are still forthcoming and it is unknown if treatment of FAI will prevent arthrosis. PMID:23610655

  6. Arthroscopic treatment of recurrent acetabulum osteoid osteoma.

    PubMed

    Tokis, Anastasios; Tsakotos, Georgios; Demesticha, Theano

    2014-04-01

    In this case report, arthroscopic treatment of a recurrent osteoid osteoma in the posterior column of the pelvis extending to the acetabular fovea in a young adolescent is being presented. PMID:24346741

  7. Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture

    PubMed Central

    Cha, Seung-Do; Gwak, Heui-Chul; Ha, Dong-Jun; Kim, Jong-Yup; Kim, Ui-Cheol; Jang, Yue-Chan

    2015-01-01

    Background The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. Methods A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. Results Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. Conclusions Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes. PMID:26640633

  8. Technical guide and tips on the all-arthroscopic Latarjet procedure.

    PubMed

    Rosso, Claudio; Bongiorno, Vito; Samitier, Gonzalo; Dumont, Guillaume D; Szöllösy, Gregor; Lafosse, Laurent

    2014-05-10

    Shoulder dislocation and subsequent anterior instability is a common problem in young athletes. The arthroscopic Bankart repair was originally described by Morgan et al. in 1987. The procedure has benefited from many technical advancements over the past 25 years and currently remains the most commonly utilized procedure in the treatment of anterior glenohumeral instability without glenoid bone loss. Capsulolabral repair alone may not be sufficient for treatment of patients with poor capsular tissue quality and significant bony defects. In the presence of chronic anterior glenoid bony defects, a bony reconstruction should be considered. The treatment of anterior shoulder instability with transfer of the coracoid and attached conjoint tendon such as the Latarjet procedure has provided reliable results. The arthroscopic Latarjet procedure was described in 2007 by the senior author, who has now performed the procedure over 450 times. The initial surgical technique has evolved considerably since its introduction, and this article presents a comprehensive update on this demanding but well-defined procedure. This article reviews technical tips to help the surgeon perform the surgery more smoothly, navigate through challenging situations, and avoid potential complications. Level of evidence V. PMID:24817106

  9. Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years

    PubMed Central

    Robinson, Elisabeth C.; Thangamani, Vijay B.; Kuhn, Michael A.; Ross, Glen

    2015-01-01

    Background: Shoulder instability in the older patient traditionally has received less attention in the literature than in the younger patient population. However, when traumatic dislocation does occur, these patients often still have frequent pain, disability, and even continued instability. Purpose: To characterize the pathoanatomy of traumatic anterior shoulder instability in the older patient population and to discuss the correlating symptoms that ultimately led to operative treatment. Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of an initial traumatic anterior shoulder instability event occurring after the age of 35 years who underwent arthroscopic surgical intervention were prospectively enrolled. Exclusion criteria included posterior instability, major fractures of the shoulder girdle, and multidirectional instability. All patients initially underwent a period of nonoperative rehabilitation. Operative treatment was performed if a patient continued to have pain and/or instability. Operative reports and arthroscopic pictures were reviewed for pathoanatomical findings. Results: A total of 27 patients (28 shoulders) met the inclusion criteria and were analyzed in this study (22 men and 5 women; mean age, 55 years; age range, 35-74 years). Surgical intervention was performed for recurrent instability in 7 patients, pain for 8 patients, and pain with instability for 13 patients. Arthroscopic findings demonstrated 18 rotator cuff tears (RCTs) (64.3%) and 18 Bankart lesions (64.3%). Nine patients had both an RCT combined with a Bankart lesion (32.1%). Three humeral avulsion of the glenohumeral ligament (HAGL) lesions (10.7%) and 2 anterior labral periosteal sleeve avulsion (ALPSA) lesions (7.1%) were found. All shoulders demonstrated Hill-Sachs lesions of various size and depth. Conclusion: Traumatic shoulder instability in the older patient may result in a wide array of pathologic findings as well as a diversity of clinical presentations. These findings suggest that the clinical diagnostician should maintain a high index of suspicion for RCT, Bankart lesions, and HAGL lesions in older patients who remain symptomatic after traumatic anterior shoulder instability.

  10. Arthroscopic Hip Revision Surgery for Residual FAI

    PubMed Central

    Larson, Christopher M.; Giveans, Russell; Bedi, Asheesh; Samuelson, Kathryn M.; Stone, Rebecca M.

    2014-01-01

    Objectives: There is a steep surgical learning curve when managing femoroacetabular impingement (FAI) and residual FAI can lead to continued pain and disability. There is very limited data reporting outcomes after revision arthroscopy for residual FAI. Methods: The records of patients that underwent arthroscopic hip revision surgery for residual FAI based on plain radiographs and 3D CT scans were reviewed. Pre and post-operative structural pathomorphology, intra-operative findings, and pre and post-operative outcomes measures using Modified Harris Hip Scoring (MHHS), SF-12 scoring, and pain on a visual analogue scale (VAS) were evaluated. Outcomes after revision arthroscopic FAI correction were compared to a cohort that underwent primary arthroscopic FAI correction. Results: 59 patients (85 hips) underwent arthroscopic revision FAI correction (mean 20.8 months follow-up). There were 98 previous arthroscopic surgeries and 4 previous surgical dislocations. There were 39 males and 46 females with a mean age of 29.5 years (range 16 - 59). 80 hips had residual cam-type FAI, and 64 hips had residual pincer-type FAI and underwent femoral and rim resections, respectively. The labrum was debrided in 27 hips, repaired in 48 hips and reconstructed with allograft in 8 hips. Adhesions were excised for 54 hips. The results of revision arthroscopic FAI correction were compared to 154 patients (169 hips) that underwent primary arthroscopic FAI correction (mean 25.2 months follow-up). The mean improvement for outcomes scores after revision FAI correction was 18.9 points (MHHS, p<.01), 13.4 points (SF-12, p<.01), and 2.2 points (VAS, p<.01) compared to 23.7 points (MHHS, p<.01), 22.3 points (SF-12, p<.01), and 4.6 points (VAS, p<.01) after primary arthroscopic FAI correction. Most recent outcomes scores and mean improvement in outcome scores were significantly better after primary (81.1% good/ excellent results) compared to revision (69.8% good/excellent results) FAI correction (MHS (p>.05), SF-12 (p<.01), VAS (p<.01). Conclusion: With appropriate indications and expectations, arthroscopic hip revision surgery for residual FAI led to significantly improved outcome measures. Outcomes, however, were inferior to those after primary arthroscopic FAI corrective surgery.

  11. All-arthroscopic repair of arcuate avulsion fracture with suture anchor.

    PubMed

    Zhang, Hui; Hong, Lei; Wang, Xue-Song; Zhang, Jin; Liu, Xin; Feng, Hua

    2011-05-01

    Arcuate avulsion fractures are very rare but present pathologic posterolateral rotation instability. Untreated instability may lead to overload of the reconstructed posterior cruciate ligament (PCL) graft. Surgical treatment and clinical results have not yet been reported to our knowledge. This study presents the case of a 45-year-old man with PCL injury and an arcuate avulsion fracture of the fibular head. The dial test was positive preoperatively, and magnetic resonance imaging showed an "arcuate" sign. The avulsed bone fragment was reduced and fixed with a suture anchor by an all-arthroscopic technique. At the 1-year follow-up, the patient had resumed all his normal activities, including sports. He scored 1+ on the posterior drawer test, and external rotation was 1° less than that in his contralateral normal knee. Compared with the values in the contralateral normal knee, the posterior tibial translation was reduced from 15.5 mm preoperatively to 6.3 mm postoperatively. The postoperative magnetic resonance imaging and computed tomography scans showed that the reconstructed PCL graft and the osseous fragment of the styloid process of the fibular head attached to the popliteofibular ligament were reduced. This technical note describes an all-arthroscopic reduction and fixation technique of arcuate avulsed fracture of the fibular head. PMID:21398077

  12. Arthroscopic Distal Tibial Allograft Augmentation for Posterior Shoulder Instability With Glenoid Bone Loss

    PubMed Central

    Gupta, Anil K.; Chalmers, Peter N.; Klosterman, Emma; Harris, Joshua D.; Provencher, Matthew T.; Romeo, Anthony A.

    2013-01-01

    Glenoid bone loss is commonly associated with recurrent shoulder instability. Failure to recognize and appropriately address it can lead to poor outcomes. Numerous studies have found anterior-inferior glenoid bone loss in the setting of recurrent anterior instability. Though much less common, posterior shoulder instability can be seen in the setting of acute trauma, epilepsy, electrocution, and alcoholism. Heightened awareness has led to recognition in collision athletes as well. Posterior glenoid bone loss must be addressed in a similar fashion to anterior glenoid bone loss to prevent recurrent instability. Open bone augmentation procedures have been described with successful results. In this technical note, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation. In addition, a current review regarding the diagnosis and management of recurrent posterior shoulder instability is provided. PMID:24400190

  13. Superior Labral Anterior Posterior Lesions of the Shoulder

    PubMed Central

    Malal, Joby Jacob George; Khan, Yousaf; Farrar, Graville; Waseem, Mohammed

    2013-01-01

    Superior labrum anterior and posterior (SLAP) lesion is of fairly recent description and its understanding is rapidly evolving. Its incidence and need for surgical treatment has increased exponentially in line with the increase in shoulder arthroscopies. It is of particular importance in the elite over head athlete and the young. A range of arthroscopic techniques and devices have been described with good functional results. The ability to return to pre injury level of sports remains a concern. PMID:24082975

  14. Arthroscopic treatment of glenoid fractures.

    PubMed

    Bauer, Thomas; Abadie, Olivier; Hardy, Philippe

    2006-05-01

    The patient was placed in the lateral decubitus position. The arthroscope was introduced through the posterior approach. The probe hook was introduced through a working cannula through the anterosuperior portal performed in an inside-out technique. The mobilization possibilities of the osteochondral fragments were then assessed. The use of a shaver was always necessary to clean the fracture site and evacuate clots. A nonabsorbable suture was passed through the labrum and the capsule tissue of the displaced articular fragment in its superior edge. The first suture was used as a traction stitch and allowed replacing the fragment in its original position and maintaining it during the placement of others sutures. A hole was made in the anterosuperior edge of the nonfractured glenoid and then a long drill was passed backward according to the transglenoid suture technique of Caspari or Morgan. Stitches were passed through the glenoid to the infraspinatus fossa. When articular congruity was judged satisfactory, the stitches were tied on the fascia of the infraspinatus muscle. The patients were immobilized in a sling for 3 weeks. PMID:16651173

  15. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique.

    PubMed

    De Cupis, Vincenzo; De Cupis, Mauro

    2012-04-01

    Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

  16. Arthroscopic Reduction and Internal Fixation for Fracture of the Lateral Process of the Talus

    PubMed Central

    Funasaki, Hiroki; Hayashi, Hiroteru; Sugiyama, Hajime; Marumo, Keishi

    2015-01-01

    Fractures of the lateral process of the talus (LPT) are relatively rare. We describe arthroscopic reduction and internal fixation for a type I fracture of the LPT according to the Hawkins classification. Preoperative computed tomography is necessary to evaluate the type and displacement of the LPT fracture because this type of fracture is often overlooked on a plain radiograph. The ankle is approached through a standard medial portal as the working portal and an anterolateral portal as the viewing portal. A 2.7-mm-diameter 30° arthroscope is used. Hematoma and soft tissues around the talus are cleared with a motorized shaver, and the anterior and lateral aspects of the talar process are visualized. Fracture reduction is obtained by pushing the lateral fragment of the lateral process medially and is fixed temporally with a 1.1-mm guidewire from the medial portal under both arthroscopy and fluoroscopy. A headless compression screw is inserted through the guidewire. Arthroscopic reduction and internal fixation for a type I LPT fracture can be easily accomplished, and return to daily and sports activities can be achieved in a relatively short time. PMID:25973380

  17. Asymmetries in explosive strength following anterior cruciate ligament reconstruction

    PubMed Central

    Knezevic, Olivera M.; Mirkov, Dragan M.; Kadija, Marko; Nedeljkovic, Aleksandar; Jaric, Slobodan

    2014-01-01

    Background Despite its apparent functional importance, there is a general lack of data regarding the time-related changes in explosive strength and the corresponding side-to-side asymmetries in individuals recovering from an ACL reconstruction (ACLR). The present study was designed to assess changes in the maximum and explosive strength of the quadriceps and hamstrings muscle in athletes recovering from an ACLR. Methods Twenty male athletes with an ACL injury completed a standard isometric testing protocol pre-ACLR, 4 and 6 months post-ACLR. In addition to the maximum strength (Fmax), the explosive strength of quadriceps and hamstrings was assessed through 4 variables derived from the slope of the force-time curves over various time intervals (RFDmax, RFD50, RFD150 and RFD250). Side-to-side asymmetries were calculated relative to post-ACLR measures of the uninvolved leg (“standard” asymmetries), and relative to pre-ACLR value of the uninvolved leg (“real” asymmetries). Results Pre-ACLR asymmetries in quadriceps RFD (average 26%) were already larger than in Fmax (14%) (p < 0.05). Six months post-ACLR real asymmetries in RFD variables (33-39%) were larger than the corresponding standard asymmetries (26-28%; p < 0.01). Average asymmetries in hamstrings RFD and Fmax were 10%, 25% and 15% for pre-ACLR and two post-ACLR sessions, respectively (all p>0.05). Conclusions In addition to the maximum strength, the indices of explosive strength should also be included in monitoring recovery of muscle function following an ACLR. Furthermore, pre-injury/reconstruction values should be used for the post-ACLR side-to-side comparisons, providing a more valid criterion regarding the muscle recovery and readiness for a return to sports. PMID:25112209

  18. Bicondylar tibial plateau fracture after posterior cruciate ligament reconstruction.

    PubMed

    Griesser, Michael J; McCoy, Brett W; Hussain, Waqas M; Saluan, Paul

    2015-03-01

    The authors present a report of a bicondylar tibial plateau fracture in an adolescent athlete after posterior cruciate ligament (PCL) reconstruction. The procedure was performed via arthroscopic transtibial PCL reconstruction with quadrupled semi-tendinosus and gracilis autograft. The patient recovered uneventfully postoperatively and was able to participate in high-level sports activity, such as baseball and track, with no limitations, no subjective complaints, and no episodes of instability. He continued to be asymptomatic up to 3.5 years postoperatively. Almost 4 years postoperatively, the patient reinjured the left knee during recreational noncontact football and was seen emergently. Plain radiographs, magnetic resonance image scan, and computed tomography scan at the time of injury showed a bicondylar tibial plateau fracture with intra-articular involvement. Operative intervention was undertaken for open reduction and internal fixation of the bicondylar tibial plateau fracture. A plate was placed along the medial aspect of the tibia with locking and nonlocking screws, and the joint line was restored appropriately. The patient recovered uneventfully and at the most recent follow-up had full active and passive range of motion, had no subjective or objective evidence of instability, and had returned to full activity with no restrictions. The patient had no history of multiple fractures or any medical or pharmacologic history that predisposed him to decreased bone density. This case shows a unique possible complication after transtibial PCL reconstruction in an adolescent patient. PMID:25760514

  19. Arthroscopic Osteochondral Grafting for Radiocarpal Joint Defects

    PubMed Central

    Ho, Pak-cheong; Tse, Wing-Iim; Wong, Clar Wing-Yee; Chow, Esther Ching-San

    2013-01-01

    Background Focal chondral lesion is a common cause of chronic wrist pain. The best treatment remains unknown. We have developed a technique of arthroscopic transplantation of an osteochondral autograft from the knee joint to the distal radius with satisfactory clinical results. Materials and Methods Between December 2006 and December 2010, four patients (average age 31 years) with posttraumatic osteochondral lesions over the dorsal lunate fossa were treated with arthroscopic osteochondral grafting. Pre- and postoperative motion, grip strength, wrist functional performance score, pain score, and return to work status were charted. Postoperative computed tomography (CT) scan, magnetic resonance imaging (MRI), and second-look arthroscopy were performed to assess graft incorporation. Description of Technique With the arthroscope in the 3-4 portal, synovitis over the dorsal lunate fossa was débrided to uncover the underlying osteochondral lesion. We employed the 6-mm trephine of the Osteoarticular Transfer System (OATS) to remove the osteochondral defect. Osteochondral graft was harvested from the lateral femoral condyle and delivered into the wrist joint arthroscopically. Results In all cases, grafts incorporation was completed by 3-4 months postoperative. All patients showed improvement in the wrist performance score (preoperative 27.5, postoperative 39 out of 40) with no pain on final follow-up at average 48.5 months (range 24-68 months). Grip strength improved from 62.6 to 98.2% of the contralateral side. Motion improved from 115.5 to 131.3°. X-ray images showed preserved joint space. Patient satisfaction was high with no complication. Conclusion An arthroscopic-assisted transfer of an osteochondral graft is a viable treatment option for chondral defects of the distal radius. PMID:24436819

  20. Treatment of tibial eminence fractures with arthroscopic suture fixation technique: a retrospective study

    PubMed Central

    Yuan, Yanhao; Huang, Xiaohan; Zhang, Yanjie; Wang, Zhanchao

    2015-01-01

    Aims: The present study aims to investigate the clinical outcomes of arthroscopic suture fixation in treating tibial eminence fracture with a retrospective study design of two years’ follow-up. Methods: A total of 33 patients with imaging evidence of tibial eminence avulsion fractures who underwent arthroscopic surgery between 2008 and 2012 were included in this study. The inclusion criteria for the study were a displaced tibial eminence avulsion fracture and anterior knee instability of grade II or higher inskeletally mature patients. These patients were treated with arthroscopic suture fixation and followed with a mean period of 24 months. Anteroposterior and lateral radiographs were obtained 3 months postoperatively to assess fracture healing. At 24 months after surgery, all patients were evaluated by an independent orthopaedic professor with clinical examination like anteroposterior laxity (Lachman-Noulis and anterior drawer tests) and Rolimeter knee tester (Aircast, Vista, CA). Knee range of motion was evaluated actively and passively with a goniometer. Knee function was evaluated by the Lysholm and International Knee Documentation Committee (IKDC) scores. Knee radiographs in standing anteroposterior, standing lateral, and Merchant views were examined for alignment, joint space narrowing, and degenerative knee changes. Results: No major complication like infection, deep venous thrombosis, or neurovascular deficit happened peri-operatively. At the final follow-up, there were no symptoms of instability and no clinical signs of ACL deficiency. Radiographs showed that all fractures healed 3 months post-operative, but at the last follow-up, there was one person with degenerative changes like joint space narrowing in radiographs. Anterior translation of the tibia was 0.47 mm on average (0 to 2.5 mm) compared with the uninjured side. Range-of-motion measurement showed a mean extension deficit of 1.5° (0° to 5°) and a mean flexion deficit of 2.7° (0° to 10°) compared with the unaffected side. The mean Lysholm score was 96 (85 to 100), and the mean IKDC score was 94 (80 to 100). Overall, the IKDC grade was A (normal) in 24 patients (58%), B (nearly normal) in 8 patients (33%), and C (abnormal) in 1 patient (8%). Conclusion: The present study demonstrated tibial eminence fractures in adults can be effectively treated with arthroscopic suture fixation. PMID:26550328

  1. Arthroscopic removal of an osteoid osteoma of the acetabulum.

    PubMed

    Barnhard, Renske; Raven, Eric E J

    2011-09-01

    In this case report, we describe the arthroscopic removal of an osteoid osteoma from the acetabulum in a young adolescent. After identifying the osteoid osteoma close to the cartilage with MRI and CT investigations, we decided that in this case, arthroscopic removal was the best treatment. In the case of an osteoid osteoma in the acetabulum close to the cartilage, arthroscopic removal should be considered as one can treat the associated osteochondritic lesion during this procedure. PMID:21445593

  2. Arthroscopic knots and strength sutures for rotator cuff repair.

    PubMed

    Longo, Umile Giuseppe; Buchmann, Stefan; Berton, Alessandra; Maffulli, Nicola; Denaro, Vincenzo

    2011-09-01

    Most arthroscopic rotator cuff reconstruction techniques require a method of securing the tendon to the bone to obtain a stable construct. The available options include knotless technology and suture welding, but the most common method uses suture anchors and knots. Tissue quality, surgical technique, repair material, and tension overload influence the stability of tissue repair. Arthroscopic knots are technically demanding because they are tied through cannulas with long-handled knot pushers. The strength of the repair is also influenced by the suture material used. In this study, we review the state-of-the-art of arthroscopic knots and suture materials being used for arthroscopic rotator cuff repair. PMID:21822109

  3. Arthroscopic Distal Clavicular Autograft for Treating Shoulder Instability With Glenoid Bone Loss

    PubMed Central

    Tokish, John M.; Fitzpatrick, Kelly; Cook, Jay B.; Mallon, William J.

    2014-01-01

    Glenoid bone loss is a significant risk factor for failure after arthroscopic shoulder stabilization. Multiple options are available to reconstruct this bone loss, including coracoid transfer, iliac crest bone graft, and osteoarticular allograft. Each technique has strengths and weaknesses. Coracoid grafts are limited to anterior augmentation and, along with iliac crest, do not provide an osteochondral reconstruction. Osteochondral allografts do provide a cartilage source but are challenged by the potential for graft rejection, infection, cost, and availability. We describe the use of a distal clavicular osteochondral autograft for bony augmentation in cases of glenohumeral instability with significant bone loss. This graft has the advantages of being readily available and cost-effective, it provides an autologous osteochondral transplant with minimal donor-site morbidity, and it can be used in both anterior and posterior bone loss cases. The rationale and technical aspects of arthroscopic performance will be discussed. Clinical studies are warranted to determine the outcomes of the use of the distal clavicle as a graft in shoulder instability. PMID:25264509

  4. Arthroscopic Excision of Acetabular Osteoid Osteoma: Computer Tomography-Guided Approach.

    PubMed

    Tamam, Cüneyt; Howse, Elizabeth A; Tamam, Muge; Barnes, Ryan H; Kelsey, Thomas J; Perry, Brad; Stubbs, Allston J

    2015-04-01

    Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as an effective treatment, with the advantage of less potential damage to normal bone and cartilage, as well as the additional benefits available with hip arthroscopy. PMID:26052484

  5. Arthroscopic Excision of Acetabular Osteoid Osteoma: Computer Tomography–Guided Approach

    PubMed Central

    Tamam, Cüneyt; Howse, Elizabeth A.; Tamam, Muge; Barnes, Ryan H.; Kelsey, Thomas J.; Perry, Brad; Stubbs, Allston J.

    2015-01-01

    Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as an effective treatment, with the advantage of less potential damage to normal bone and cartilage, as well as the additional benefits available with hip arthroscopy. PMID:26052484

  6. Glenoid fracture after arthroscopic Bankart repair: case series and biomechanical analysis.

    PubMed

    Farmer, Kevin W; Uribe, John W; Moser, Michael W; Conrad, Bryan C; Yagnik, Gautam P; Wright, Thomas W

    2014-01-01

    To examine whether anchors used in arthroscopic Bankart repair increased the risk of subsequent fracture, six intact polyurethane scapulae and six with three 3.0-mm suture anchors placed along the anteroinferior glenoid were compared. An axial load of 1 mm/s was applied to the anteroinferior glenohumeral joint with a prosthetic humeral head. Outcome measures were force needed for initial fracture and catastrophic failure, percent of anterior glenoid bone loss, and fracture length. With the numbers available, no significant differences could be detected between groups in yield load or maximum load. The anchor group had a significantly larger percentage of bone loss (p < .01) and fracture length (p < .01) compared to the intact group. In this study, anchors did not decrease force needed to fracture but did lead to significantly larger fractures of the anterior glenoid during a simulated dislocation event. Further study using various anchors and techniques is warranted. PMID:25153814

  7. Arthroscopic stapling repair for chronic lateral instability.

    PubMed

    Hawkins, R B

    1987-10-01

    We have presented a preliminary report on a limited number of patients with chronic lateral instability of the ankle treated with arthroscopic stapling reconstruction. As stated, the longest follow-ups are about 5 years, so the results over the long term are not yet known. Early adults have been quite encouraging, however, with improved functional stability of the ankle. Only one patient in more than two dozen has had recurrent instability that required more surgery. He returned with a history of additional sports trauma. The principle of secure fixation of ligaments to exposed bone surfaces with staples is a well-accepted and effective technique familiar to surgeons for many years. What is changing is that microsurgical techniques can be adapted to common orthopedic problems. Ankle arthroscopy is expanding continually to meet the needs of many patients. Discomfort is minimal, and many patients do not even fill their prescriptions for analgesic medication. The period of disability is relatively short and rehabilitation is rapid. Because most patients prefer arthroscopy to an open procedure, we must continue to explore all avenues of surgical technique. New tools and developments are constantly on the horizon. As in most arthroscopic surgical procedures, instruments of the correct size are most important, as is precise surgical technique. The key to successful arthroscopic surgery is careful forethought, meticulous planning, constant education, and a dependable team. PMID:2960443

  8. Arthroscopic treatment in split depression-type tibial pilon fracture.

    PubMed

    Lonjon, Guillaume; Delgrande, Damien; Solignac, Nicolas; Faivre, Bruno; Hardy, Philippe; Bauer, Thomas

    2015-02-01

    Treatment of tibial pilon fractures is complicated and often very invasive. Partial fractures with a depressed component raise the question of the choice of surgical technique. Minimally invasive surgical reduction under arthroscopic guidance appears to be a promising alternative in this type of fracture. We describe a technique for arthroscopically assisted treatment of a split depression tibial pilon fracture. PMID:24898416

  9. Arthroscopic Assessment and Treatment of Dancers' Knee Injuries.

    ERIC Educational Resources Information Center

    Silver, Daniel M.; Campbell, Pat

    1985-01-01

    Arthroscopic examination of 16 dancers with dance-related knee injuries which defied conservative treatment showed 15 meniscal tears and 4 cases of chondromalacia patellae. Partial arthroscopic meniscectomy was used to treat the tears. The results were excellent, with 13 of the 16 returning to preoperative levels of dance activity. (MT)

  10. Genetic basis of cranial cruciate ligament rupture (CCLR) in dogs.

    PubMed

    Baird, Arabella Elizabeth Gardiner; Carter, Stuart D; Innes, John F; Ollier, William E; Short, Andrea D

    2014-08-01

    Cranial Cruciate Ligament rupture (CCLR) is one of the most common forms of lameness in dogs and is analogous to rupture of the anterior cruciate ligament in humans, for which it can serve as a model. As there is a strong breed-related predisposition to CCLR in dogs, a study was undertaken to consider putative genetic components in susceptible dog breeds. A candidate gene, single nucleotide polymorphism (SNP) genotyping approach using MALDI-TOF mass spectrometry (Sequenom Ltd) was designed to investigate several CCLR-susceptible dog breeds and identify CCLR-associated genes/gene regions that may confer susceptibility or resistance. A meta-analysis was performed using the breed case/control candidate gene data to identify SNP associations that were common to the whole cohort of susceptible dogs. We identified SNPs in key genes involved in ligament strength, stability and extracellular matrix formation (COL5A1, COL5A2, COL1A1, COL3A1, COL11A1, COL24A1, FBN1, LOX, LTBP2) which were significantly associated with CCLR susceptibility across the dog breeds used in this study. These SNPs could have an involvement in CCLR due to a detrimental effect on ligament structure and strength. This is the first published candidate gene study that has revealed significant genetic associations with canine CCLR. PMID:24684544

  11. Posterior Cruciate Ligament Reconstruction Using Single-Bundle Achilles Allograft with Open Tibial Inlay Fixation

    PubMed Central

    Zehir, Sinan; Elmal?, Nurzat; Çalb?y?k, Murat; Ta?demir, Zeki; Sa?lam, Fevzi

    2014-01-01

    Objectives: PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation. Methods: We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months). The patients were 11males and 3 females with an average age of 29.2 years (17-41 years). Ipsilateral femoral shaft fractures were determined in 2 cases, ipsilateral trochanteric fracture in 1 case and popliteal artery injury in 1 case. Surgery was performed within 2-4 weeks. Spanning-joint external fixation was applied to 2 patients because of gross instability with failure to maintain reduction in a brace. Combined reconstructions involving the posterolateral corner (9/14), anterior cruciate ligament (ACL (11/14)), or medial collateral ligament (MCL (1/14)) were performed. All PCL reconstructions were performed with Achilles allograft. In 1 case with arterial injury, the repair was made by a cardiovascular surgeon. In 2 case, deep infection developed, which was controlled with debridement and antibiotic treatment. Superficial peroneal nerve injury in 1 case was treated with tenolysis in the 6th month, then partial healing was seen at 18 months. In all patients, the preoperative posterior drawer (PD) examination was positive. All patients were evaluated with preoperative and postoperative examination and x-rays. The International Knee Documentation Committee (IKDC) evaluation was applied to all patients at the final follow-up. Results: Postoperative PD examination demonstrated the following: 0 (normal) in 4 patients, 1+ in 7 patients, and 2+ in 3 patients, compared to the preoperative PD of 3+ or greater in all patients. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. The final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 6 knees; C, 3 knees and D, 1 knee, compared to D in all 14 knees preoperatively. The average final follow-up IKDC subjective score was 74.1 (20-100). Conclusion: Despite transtibial PCL reconstruction being advocated by several authors, it has technical difficulties of the arthroscopic approach to the posterior compartment of the knee. In the open inlay technique, posterior arthrotomy allows accurate placement of the tibial PCL insertion, avoiding the killer curve and more closely duplicating the normal PCL anatomy. Based on our initial experience with this technique at early follow-up, we continue to use the tibial inlay technique as our preferred technique for isolated or combined reconstruction of the PCL.

  12. Arthroscopic all inside repair of the lateral meniscus root tear.

    PubMed

    Ahn, Jin Hwan; Lee, Yong Seuk; Chang, Jae-Young; Chang, Moon Jong; Eun, Sang Soo; Kim, Sang Min

    2009-01-01

    It has been reported that lateral meniscus tears, including posterior horn tears, stable radial flap tears, or peripheral or posterior third tears that are combined with an Anterior Cruciate Ligament (ACL) injury can be treated with being left in situ. However, our experience has shown that the tear patterns are not so simple. They can show complex configurations and the inner side can be lost in chronic cases. Regarding the repair technique, there has been some controversy concerning the follow up results with repair devices and reduction is difficult using these devices if the inner side is non-viable or lost. If the tear involves whole width of bony insertion, it is believed that the meniscal function would be lost, particularly because the anatomic configuration is different in this area. In cases of chronic inner loss types, the meniscus was repaired using a side to side repair or pull out repair technique. Complete healing was achieved using this technique in some patients. Conclusively, Posterior Lateral Meniscus Root Tear (PLMRT) must be managed with different method with tears of other areas because the tear configuration is complex than simple looking. PMID:18930402

  13. A Biomechanical Evaluation of Anterior and Posterior Tibialis Tendons as Suitable Single-Loop Anterior Cruciate

    E-print Network

    Hull, Maury

    or failure of an allograft transplant include immunogenicity, pres- ervation and secondary sterilization, disease transmis- sion, and remodeling and its effect on mechanical properties. Previous clinical studies

  14. Arthroscopic treatment for chronic lateral epicondylitis?

    PubMed Central

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

    2015-01-01

    Objective To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Methods Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. Results A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p < 0.01). No correlations were observed using the Spearman test between the results and age, gender, length of time with symptoms before the operation or injury mechanism (p > 0.05). Conclusion Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure. PMID:26401498

  15. Arthroscopic treatment of synovial osteochondromatosis of the elbow. Case report and literature review.

    PubMed

    Terra, Bernardo Barcellos; Moraes, Eduardo Wanzenboeck; de Souza, Alceuleir Cardoso; Cavatte, José Maria; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Synovial osteochondromatosis is a benign proliferative disorder with metaplasia of the synovial membrane that affects the fibroblasts of the synovial joints, tendons and bursae. In literature, there are few descriptions of synovial osteochondromatosis of the elbow. The objective of this article was to report a case of synovial osteochondromatosis of the elbow in a patient aged 32, basketball athlete, in which surgical treatment was chosen because of the pain and functional limitation and stage of disease with multiple loose bodies. Patient 32, male, presented with pain and limitation of motion of the elbow. The range of passive motion was 100° of flexion and 30° extension. The range of active motion was 40-90°. Magnetic resonance observed many loose bodies mainly in the posterior compartment in the olecranon fossa plus some chondral lesions in the capitellum. The arthroscopic treatment was chosen with two anteriors portals (medial and lateral) and two posterior portals (standard posterior and posterolateral) for easing loose bodies and osteoplasty of the olecranon fossa. The visual analog scale pain was 9-3 and its arc of active motion was 110° to -20° of flexion and extension. On a scale of performance from Mayo Clinic patients was 65 points preoperatively to 90 postoperatively with 9 months follow-up and the patient was satisfied with the treatment outcome. Arthroscopic treatment of synovial osteochondromatosis of the elbow is an effective and safe therapeutic management with low morbidity and early return to activities. PMID:26535210

  16. Arthroscopic treatment of synovial osteochondromatosis of the elbow. Case report and literature review?

    PubMed Central

    Terra, Bernardo Barcellos; Moraes, Eduardo Wanzenboeck; de Souza, Alceuleir Cardoso; Cavatte, José Maria; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Synovial osteochondromatosis is a benign proliferative disorder with metaplasia of the synovial membrane that affects the fibroblasts of the synovial joints, tendons and bursae. In literature, there are few descriptions of synovial osteochondromatosis of the elbow. The objective of this article was to report a case of synovial osteochondromatosis of the elbow in a patient aged 32, basketball athlete, in which surgical treatment was chosen because of the pain and functional limitation and stage of disease with multiple loose bodies. Patient 32, male, presented with pain and limitation of motion of the elbow. The range of passive motion was 100° of flexion and 30° extension. The range of active motion was 40–90°. Magnetic resonance observed many loose bodies mainly in the posterior compartment in the olecranon fossa plus some chondral lesions in the capitellum. The arthroscopic treatment was chosen with two anteriors portals (medial and lateral) and two posterior portals (standard posterior and posterolateral) for easing loose bodies and osteoplasty of the olecranon fossa. The visual analog scale pain was 9–3 and its arc of active motion was 110° to ?20° of flexion and extension. On a scale of performance from Mayo Clinic patients was 65 points preoperatively to 90 postoperatively with 9 months follow-up and the patient was satisfied with the treatment outcome. Arthroscopic treatment of synovial osteochondromatosis of the elbow is an effective and safe therapeutic management with low morbidity and early return to activities. PMID:26535210

  17. The biomechanics of cruciate ligament repair 

    E-print Network

    Ferry, Katheryn Irene

    2013-02-22

    Although numerous surgical procedures have been designed to restore stability of a ruptured cranial cruciate ligament (CrCL), the technique for reconstruction has not been perfected. Graft failure due to excessive strain is a serious complication...

  18. Anaesthetic management of shoulder arthroscopic repair in Parkinson's disease with deep brain stimulator

    PubMed Central

    Gandhi, Ranju; Chawla, Reeta

    2014-01-01

    We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson's disease (PD) with deep brain stimulator (DBS) using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG) normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS. PMID:25024475

  19. Comparison of Bristow procedure and Bankart arthroscopic method as the treatment of recurrent shoulder instability

    PubMed Central

    Zarezade, Abolghasem; Dehghani, Mohammad; Rozati, Ali Reza; Banadaki, Hossein Saeid; Shekarchizade, Neda

    2014-01-01

    Background: Anterior shoulder dislocation is the most common major joint dislocation. In patients with recurrent shoulder dislocation, surgical intervention is necessary. In this study, two methods of treatment, Bankart arthroscopic method and open Bristow procedure, were compared. Materials and Methods: This clinical trial survey had been done in the orthopedic department of Alzahra and Kashani hospitals of Isfahan during 2008-2011. Patients with recurrent anterior shoulder dislocation who were candidates for surgical treatment were randomly divided into two groups, one treated by Bankart arthroscopic technique and the other treated by Bristow method. All the patients were assessed after the surgery using the criteria of ROWE, CONSTANT, UCLA, and ASES. Data were analyzed by SPSS software. Results: Six patients (16.22%) had inappropriate condition with ROWE score (score less than 75); of them, one had been treated with Bristow and five with Bankart (5.26 vs. 27.78). Nine patients (24.32%) had appropriate condition, which included six from Bristow group and three treated by Bankart technique (31.58 vs. 16.67). Finally, 22 patients (59.46%) showed great improvement with this score, which included 12 from Bristow and 10 from Bankart groups (63.16 vs. 55.56). According to Fisher's exact test, there were no significant differences between the two groups (P = 0.15). Conclusion: The two mentioned techniques did not differ significantly, although some parameters such as level of performance, pain intensity, use of analgesics, and range of internal rotation showed more improvement in Bristow procedure. Therefore, if there is no contraindication for Bristow procedure, it is preferred to use this method. PMID:25590034

  20. Arthroscopic Acetabular Rim Resection in the Treatment of Femoroacetabular Impingement

    PubMed Central

    Chow, Roxanne M.; Krych, Aaron J.; Levy, Bruce A.

    2013-01-01

    Appropriate identification and precise resection of the pincer lesion are integral parts of the arthroscopic surgical treatment of femoroacetabular impingement. Preoperative radiographic planning of the bone resection, as well as executing the plan intraoperatively using both fluoroscopic and arthroscopic cues, is critical to adequately removing the pincer lesion. We present our surgical technique of removing the impinging bone by defining the focal acetabular rim overcoverage, accessing the pincer lesion with labral detachment, and then performing acetabular rim resection. PMID:24400176

  1. Arthroscopic-Assisted Fixation of Ideberg Type III Glenoid Fractures

    PubMed Central

    Tao, Matthew A.; Garrigues, Grant E.

    2015-01-01

    Operative treatment of scapular fractures with extension into the glenoid can be a challenging clinical scenario. Though traditionally addressed in an open fashion, the morbidity of this approach, complemented by advancements in arthroscopic technique and instrumentation, has led to increasing use of arthroscopic-assisted fixation. We describe our technique, including pearls and pitfalls, for minimally invasive fixation of Ideberg type III glenoid fractures. This approach minimizes morbidity, allows optimal visualization and reduction, and provides good functional results. PMID:26052487

  2. A navigation system for shoulder arthroscopic surgery.

    PubMed

    Tyryshkin, K; Mousavi, P; Beek, M; Ellis, R E; Pichora, D R; Abolmaesumi, P

    2007-10-01

    The general framework and experimental validation of a novel navigation system designed for shoulder arthroscopy are presented. The system was designed to improve the surgeon's perception of the three-dimensional space within the human shoulder. Prior to surgery, a surface model of the shoulder was created from computed tomography images. Intraoperatively, optically tracked arthroscopic instruments were calibrated. The surface model was then registered to the patient using tracked freehand ultrasound images taken from predefined landmark regions on the scapula. Three-dimensional models of the surgical instruments were displayed, in real time, relative to the surface model in a user interface. Laboratory experiments revealed only small registration and calibration errors, with minimal time needed to complete the intraoperative tasks. PMID:18019466

  3. The “Flying Swan” Technique: A Novel Method for Anterior Labral Repair Using a Tensioned Suture Bridge

    PubMed Central

    Alexander, Susan; Wallace, Andrew L.

    2014-01-01

    Arthroscopic labral repair is an effective technique for most cases of traumatic shoulder instability. However, patients with anterior labroligamentous periosteal sleeve avulsion lesions frequently have multiple episodes of subluxation or dislocation and a high recurrence rate after surgery, even with modern methods of labral repair. One reason may be failure of biological healing of the labrum due to an inadequate “footprint” of contact between the capsulolabral tissue and the glenoid bone. We have developed a technique that facilitates a tensioned suture bridge between suture anchors that may improve the results of labral repair in patients with anterior labroligamentous periosteal sleeve avulsion lesions. PMID:24749030

  4. Transtibial Tunnel Placement in Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Tompkins, Marc; Keller, Thomas C.; Milewski, Matthew D.; Gaskin, Cree M.; Brockmeier, Stephen F.; Hart, Joseph M.; Miller, Mark D.

    2014-01-01

    Background: It is common to place the posterior cruciate ligament (PCL) tibial tunnel with a transtibial technique using a guide that attempts to place the center of the tunnel 1 to 1.5 cm distal to the tibiofemoral joint. It is unknown how well this technique will re-create the native tibial footprint of the PCL. Purpose: To evaluate the accuracy of tibial tunnel placement using a transtibial technique. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees from 10 donors underwent arthroscopic transtibial drilling of the tibial tunnel with use of a posteromedial portal for visualization. The transtibial guide was rested flush against the tibial spines to allow for the guide to be as distal as possible, which was between 1 and 1.5 cm distal to the tibiofemoral joint line. Using this technique, an attempt was made to place the tibial tunnels as close to the center of the PCL footprint as possible. All knees underwent computed tomography both pre- and postoperatively with a previously reported technique optimized for ligament evaluation. This allowed comparison of the anatomic PCL tibial footprint to the tibial tunnel aperture. The percentage of tunnel aperture contained within the native footprint as well as the distance from the center of the tunnel aperture to the center of the footprint was measured. Results: The percentage of tunnel aperture contained within the native footprint was 45.9% ± 23.1%. The distance from the center of the tibial tunnel aperture to the center of the tibial PCL footprint was 6.4 ± 2.3 mm. The tunnels were almost always (9/10) distal (or inferior) to the native footprint and either slightly lateral (5/10) or centered (5/10) in a medial to lateral direction. Conclusion: This study demonstrates that using the transtibial drilling technique in the tibia for PCL reconstruction places approximately half of the tibial tunnel aperture within the tibial footprint. Generally, the tunnel is distal to the footprint. Clinical Relevance: Consideration should be given to the fact that, using this transtibial technique, the tibial tunnel aperture is generally not placed in the center of the footprint. This may not be a negative issue, however, since there are other potential advantages from distal tunnel placement. PMID:26535303

  5. The “Labral Bridge”: A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair

    PubMed Central

    Ostermann, Roman C.; Hofbauer, Marcus; Platzer, Patrick; Moen, Todd C.

    2015-01-01

    Arthroscopic Bankart repair with suture anchors is widely considered a mainstay for surgical treatment of anterior shoulder instability after recurrent anterior shoulder dislocations. Traditionally, the displaced capsulolabral complex is restored and firmly attached to the glenoid by placing multiple suture anchors individually from a 5- to 3-o'clock position. A variety of different techniques using different anchor designs and materials have been described. Knotless anchors are widely used nowadays for shoulder instability repair, providing a fast and secure way of labral fixation with favorable long-term outcomes. However, these techniques result in a concentrated point load of the reduced labrum to the glenoid at each suture anchor. We describe a technique, developed by the first author, using a 1.5-mm LabralTape (Arthrex, Naples, FL) in combination with knotless suture anchors (3.5-mm PEEK [polyether ether ketone] PushLock anchors; Arthrex), for hybrid fixation of the labrum. The LabralTape is used to secure the torn labrum to the glenoid between each suture anchor, thus potentially providing a more even pressure distribution. PMID:26052499

  6. Arthroscopic Saucerization and Repair of Discoid Lateral Meniscal Tear

    PubMed Central

    Fields, Logan K.; Caldwell, Paul E.

    2015-01-01

    Meniscal tears are among the most commonly diagnosed knee injuries and often require surgical intervention. Understanding the types of meniscal tears and treatment options is paramount to caring for the young athlete. Sports medicine and arthroscopic physicians now recognize that meniscal preservation in the young athlete is essential to the long-term health and function of the knee. Although uncommon, the discoid lateral meniscus is more prone to injury because of its increased thickness and lack of blood supply. Because of the abnormal development, the peripheral attachments are frequently absent and instability often persists after a partial meniscectomy. If the instability is unrecognized during the initial treatment, a recurrence of pain and mechanical symptoms is likely and a subsequent subtotal meniscectomy may be the only treatment option. With increased awareness, arthroscopic saucerization accompanied by arthroscopically assisted inside-out meniscal repair is a preferable treatment option with an excellent outcome. PMID:26052498

  7. Simulation of arthroscopic surgery using MRI data

    NASA Technical Reports Server (NTRS)

    Heller, Geoffrey; Genetti, Jon

    1994-01-01

    With the availability of Magnetic Resonance Imaging (MRI) technology in the medical field and the development of powerful graphics engines in the computer world the possibility now exists for the simulation of surgery using data obtained from an actual patient. This paper describes a surgical simulation system which will allow a physician or a medical student to practice surgery on a patient without ever entering an operating room. This could substantially lower the cost of medial training by providing an alternative to the use of cadavers. This project involves the use of volume data acquired by MRI which are converted to polygonal form using a corrected marching cubes algorithm. The data are then colored and a simulation of surface response based on springy structures is performed in real time. Control for the system is obtained through the use of an attached analog-to-digital unit. A remote electronic device is described which simulates an imaginary tool having features in common with both arthroscope and laparoscope.

  8. Anterior knee pain

    MedlinePLUS

    Anterior knee pain is pain that occurs at the front and center of the knee. It can be caused by ... attach to the top of the kneecap) Anterior knee pain begins when the kneecap does not move properly ...

  9. Arthroscopic Labral Reconstruction of the Hip Using Local Capsular Autograft

    PubMed Central

    Domb, Benjamin G.; Gupta, Asheesh; Stake, Christine E.; Hammarstedt, Jon E.; Redmond, John M.

    2014-01-01

    Labral reconstruction is becoming an important treatment modality for hips with nonsalvageable labra. Nonsalvageable labra can be present in cases of intrasubstance damage, revision surgery after debridement, labral calcification, and hypoplasia. Previous methods of reconstruction have been performed in an open manner and arthroscopically using ligamentum teres, iliotibial band, and gracilis autograft. We present an alternate method of arthroscopic labral reconstruction using capsular autograft. The technique uses readily available capsular tissue during arthroscopy with no donor-site morbidity. This technique may be valuable in appropriately selected patients with labral deficiency. PMID:25126503

  10. Image-driven haptic simulation of arthroscopic surgery.

    PubMed

    Rasool, Shahzad; Sourin, Alexei; Kagda, Fareed

    2013-01-01

    Virtual haptic simulation of minimally invasive arthroscopic surgery becomes an extremely important training tool that allows the medical students to acquire necessary motor skills before they can approach actual patients. Normally, 3D simulation of the interior of a joint requires significant efforts from the software developers but yet remains not always photo realistic. In this paper, we propose a pioneering approach of using augmented real arthroscopic images for realistic and immersive image-driven visualization and haptic interaction within the surgical field as if it were actual three-dimensional scene where body parts displayed in the image act and feel as real 3D objects rather than their images. PMID:23400181

  11. Arthroscopic extirpation of an osteoid osteoma of the acetabulum.

    PubMed

    Alvarez, M S; Moneo, P R; Palacios, J A

    2001-09-01

    We present the case of a 16-year-old boy with an 18-month history of pain in the left groin for 18 months. In addition to the simple radiographic examination, magnetic resonance imaging, bone scan, and computed tomography were necessary to finally diagnose an acetabulum osteoid osteoma (AOO). Excision of the lesion was performed arthroscopically and pathologic testing confirmed the diagnosis. The patient's symptoms disappeared immediately after the surgery, and had not reappeared as of the 6-month postoperative evaluation. We conclude that arthroscopic excision of an AOO is possible and avoids the aggressive open approach as well as operative hip dislocation. PMID:11536099

  12. Bankart arthroscopic procedure: comparative study on use of double or single-thread anchors after a 2-year follow-up?

    PubMed Central

    Godinho, Glaydson Gomes; Freitas, José Márcio Alves; França, Flávio de Oliveira; de Lago e Santos, Flávio Márcio; Aragão, Alan Arruda; Barros, Marcos Knoll

    2014-01-01

    Objective To compare the use of anchors with double and single-thread loading in the single-row Bankart arthroscopic procedure. Methods 252 patients (258 shoulders) underwent Bankart arthroscopic surgery with evaluation after a minimum follow-up of 2 years. They underwent repairs either using anchors with single loading of a high-resistance non-absorbable braided thread (206 shoulders; group AS) or using double loading of thread with the same characteristics (52 shoulders; group AD). The patients were evaluated using the UCLA and Carter-Rowe scales. The patients’ return to sports activity and recurrences were also compared. Results There was no significant difference between the groups regarding the surgical failure rate (group AS 5.8%; group AD 7.7%; p = 0.62). Group AS presented a better mean Carter-Rowe score (group AS 94.4; group AD 88.6; p < 0.05) and greater return to the same sports level (group AS 79.1; group AD 72.1; p < 0.05). Conclusion Use of anchors with double thread loading did not show any clinical advantage for arthroscopic repair of traumatic anterior shoulder instability, in relation to use of single-thread anchors, over a 2-year follow-up. PMID:26229884

  13. Patient Satisfaction after Arthroscopic Repair of Acetabular Labral Tears

    PubMed Central

    Ha, Yong-Chan; Shin, Yong-Eun

    2014-01-01

    Background Acetabular labral tear is a main cause of hip pain and disability, often requiring surgical treatment. Improvements of hip arthroscopic technique have produced positive outcomes after labral repair with arthroscopy. The purpose of this study was to determine clinical outcomes and patient satisfaction after arthroscopic repair of acetabular labral tear. Methods We interviewed 21 patients (10 men and 11 women; mean age, 36 years [range, 22 to 57 years]) with acetabular labral tears that had been repaired arthroscopically in terms of satisfaction of the procedure. In addition, clinical outcome was assessed using visual analog scale (VAS) score, University of California, Los Angeles (UCLA) activity, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, and Harris hip score, and radiologic outcome was assessed using serial radiography. The patients were followed for 24-50 months. Results The mean Harris hip score was 73 points (range, 64 to 84 points) preoperatively and 83 points (range, 66 to 95 points) postoperatively. Fifteen hips (71%) were rated excellent and good. The mean WOMAC osteoarthritis index and VAS scores were improved at final follow-up. UCLA activity at the latest follow-up improved in 16 patients. The Tonnis grade of osteoarthritis at the latest follow-up did not change in all patients. Eighteen of the patients (86%) were satisfied with the procedure. Conclusions High rate of satisfaction after arthroscopic repair of acetabular labral tears is an encouraging outcome. Arthroscopic treatment of labral tears might be a useful technique in patients with hip pathologies, such as femoroacetabular impingement with labral tears. PMID:24900896

  14. Osseous Defects Seen in Patients with Anterior Shoulder Instability.

    PubMed

    Yamamoto, Nobuyuki; Itoi, Eiji

    2015-12-01

    Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough. PMID:26640623

  15. Osseous Defects Seen in Patients with Anterior Shoulder Instability

    PubMed Central

    Itoi, Eiji

    2015-01-01

    Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough. PMID:26640623

  16. Complications Following Arthroscopic Rotator Cuff Tear Repair

    PubMed Central

    Audigé, Laurent; Blum, Raphael; Müller, Andreas M.; Flury, Matthias; Durchholz, Holger

    2015-01-01

    Background Valid comparison of outcomes after surgical procedures requires consensus on which instruments and parameters should be used, including the recording and evaluation of surgical complications. An international standard outlining the terminology and definitions of surgical complications in orthopaedics is lacking. Purpose This study systematically reviewed the literature for terms and definitions related to the occurrence of negative events or complications after arthroscopic rotator cuff repair (ARCR) with specific focus on shoulder stiffness. Study Design Systematic review; Level of evidence, 4. Methods PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for reviews, clinical studies, and case reports of complications associated with ARCR. Reference lists of selected articles were also screened. The terminology of complications and their definitions were extracted from all relevant original articles by a single reviewer and verified by a second reviewer. Definitions of shoulder stiffness or equivalent terms were tabulated. Results Of 654 references published after 2007 and obtained from the search, 233 full-text papers (44 reviews, 155 studies, 31 case reports, and 3 surgical technique presentations) were reviewed. Twenty-two additional references cited for a definition were checked. One report defined the term surgical complication. There were 242 different terms used to describe local events and 64 to describe nonlocal events. Furthermore, 16 definitions of terms such as frozen shoulder, shoulder stiffness, or stiff painful shoulder were identified. Diagnosis criteria for shoulder stiffness differed widely; 12 various definitions for restriction in range of motion were noted. One definition included a gradation of stiffness severity, whereas another considered the patient’s subjective assessment of motion. Conclusion The literature does not consistently report on complications after ARCR, making valid comparison of the incidence of these events among published reports impossible. Specifically, the variation in criteria used to diagnose shoulder stiffness is problematic for valid and accurate reporting of this event. A standard for reporting this event and other complications after ARCR is needed. Clinical Relevance This review serves as the basis for the development of a uniform documentation process for shoulder stiffness and the standardization of complication definitions in ARCR following international consensus.

  17. Bilateral Anterior Shoulder Dislocation

    PubMed Central

    Siu, Yuk Chuen; Lui, Tun Hing

    2014-01-01

    Introduction: Unilateral anterior shoulder dislocation is one of the most common problems encountered in orthopedic practice. However, simultaneous bilateral anterior dislocation of the shoulders is quite rare. Case Presentation: We report a case of a 75-year-old woman presented with simultaneous bilateral anterior shoulder dislocation following a trauma, complicated with a traction injury to the posterior cord of the brachial plexus. Conclusions: Bilateral anterior shoulder dislocation is very rare. The excessive traction force during closed reduction may lead to nerve palsy. Clear documentation of neurovascular status and adequate imaging before and after a reduction should be performed. PMID:25685749

  18. Arthroscopic excision of osteoid osteoma in the posteroinferior portion of the acetabulum.

    PubMed

    Chang, Byeong-Keun; Ha, Yong-Chan; Lee, Young-Kyun; Hwang, Deuk-Soo; Koo, Kyung-Hoi

    2010-12-01

    Osteoid osteoma in the acetabulum is very rare and the surgical extirpation is difficult. We present a case of osteoid osteoma in the posteroinferior portion of the acetabulum which was treated with arthroscopic excision. A 29-year-old woman presented with 18 months of pain in the left groin. Computed tomography suggested an osteoid osteoma in the posteroinferior portion of the acetabulum. Arthroscopic excision of the lesion was performed with the aid of image intensifier. The patient's symptoms disappeared immediately after the surgery. This case report shows that arthroscopic excision is possible in a lesion in the posteroinferior portion in the acetabulum, which previously deemed inaccessible arthroscopically. PMID:20422402

  19. Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature.

    PubMed

    LaPrade, Christopher M; Civitarese, David M; Rasmussen, Matthew T; LaPrade, Robert F

    2015-12-01

    The posterior cruciate ligament (PCL) is recognized as an essential stabilizer of the knee. However, the complexity of the ligament has generated controversy about its definitive role and the recommended treatment after injury. A proper understanding of the functional role of the PCL is necessary to minimize residual instability, osteoarthritic progression, and failure of additional concomitant ligament graft reconstructions or meniscal repairs after treatment. Recent anatomic and biomechanical studies have elucidated the surgically relevant quantitative anatomy and confirmed the codominant role of the anterolateral and posteromedial bundles of the PCL. Although nonoperative treatment has historically been the initial treatment of choice for isolated PCL injury, possibly biased by the historically poorer objective outcomes postoperatively compared with anterior cruciate ligament reconstructions, surgical intervention has been increasingly used for isolated and combined PCL injuries. Recent studies have more clearly elucidated the biomechanical and clinical effects after PCL tears and resultant treatments. This article presents a thorough review of updates on the clinically relevant anatomy, epidemiology, biomechanical function, diagnosis, and current treatments for the PCL, with an emphasis on the emerging clinical and biomechanical evidence regarding each of the treatment choices for PCL reconstruction surgery. It is recommended that future outcomes studies use PCL stress radiographs to determine objective outcomes and that evidence level 1 and 2 studies be performed to assess outcomes between transtibial and tibial inlay reconstructions and also between single- and double-bundle PCL reconstructions. PMID:25776184

  20. Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

    PubMed Central

    Tuttle, John R.; Ramos, Paul; DaSilva, Manuel F.

    2014-01-01

    An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications. PMID:25685668

  1. Evaluation of arthroscopic treatment of posterior shoulder instability

    PubMed Central

    Garcia, José Carlos; Maia, Lucas Russo; Fonseca, Juliano Rocha; Zabeu, José Luís Amim; Garcia, Jesely Pereira Myrrha

    2015-01-01

    OBJECTIVE: To provide data for the analysis of arthroscopy as a method of surgical treatment for shoulder and discuss its actual indications and preliminary results. METHODS: We evaluated 15 patients submitted to reverse Bankart arthroscopic surgery. We used the UCLA (University of California at Los Angeles) score to measure the results before surgery and 12 months thereafter. RESULTS: The average UCLA score changed from 26.67±0.25 (SD 0.97) before surgery to 34.20±0.53 (SD 2.04) after surgery. The effectiveness of surgery was 93%. In five cases loose bodies were found. A patient undergoing remplissage was evaluated separately. The data did not change after 24 months post-surgery. CONCLUSION: The arthroscopic treatment of posterior shoulder instability and posterior dislocation of the shoulder has been proved feasible and results in our series followed the same trends as in the literature. Level of Evidence III, Transversal Retrospective Study. PMID:26207089

  2. The TOTS (temporary outside traction suture): a new technique to allow easy suture placement and improve capsular shift in arthroscopic bankart repair.

    PubMed

    Boileau, Pascal; Ahrens, Philip

    2003-01-01

    We describe a new technique to allow easy placement of anterior sutures and to improve the proximal capsular shift in arthroscopic anterior stabilization of the shoulder, which we call the temporary outside traction suture (TOTS). Two standard portals are used: posterior and anterosuperior. Using a curved suture hook, both the capsule and the labrum are perforated at approximately the 5-o'clock position, and a monofilament suture is passed through the tissues. The suture is first retrieved through the anterior canula and then placed outside the canula. After labrum detachment and glenoid preparation, 1 or 2 further inferior sutures can be placed before the first suture is retrieved inside the canula and used. The technique of the TOTS has many advantages. (1) It allows easy placement of the first suture before the anterior capsule and labrum have been released. This makes this step much more difficult due to the lack of tension in the anterior tissues and anterior subluxation of the humeral head. (2) It allows the surgeon to choose, with accuracy, the amount of capsule taken, according to the severity of the capsular lesions and the degree of capsular laxity. It can also allow anatomic recreation of the anterior band of the inferior glenohumeral ligament (IGHL). (3) By placing tension on the suture, it avoids damaging the anterior capsule and labrum with the shaver and burr while preparing the scapula neck and can aid with haemostasis. (4) Tension on the suture also allows one to easily place 1 or 2 further sutures in a lower position. (5) It avoids entangling the sutures in the canula. (6) It allows one to perform a capsular shift of approximately 10 to 15 mm when the traction suture is retrieved and implanted with an anchor in the 3- or even 2-o'clock position. PMID:12861206

  3. Arthroscopic Labral Repair in the Treatment of Femoroacetabular Impingement

    PubMed Central

    Chow, Roxanne M.; Owens, Christopher J.; Krych, Aaron J.; Levy, Bruce A.

    2013-01-01

    Labral repair has become an essential technique in the arthroscopic surgical management of femoroacetabular impingement. Several clinical studies suggest that labral repair results in superior patient outcomes in comparison to labral debridement alone. The repair procedure requires accurate evaluation of labral tissue quality, precise placement of sutures and anchors, and careful re-tensioning of the labrum. We present our preferred technique for labral repair. PMID:24400177

  4. Femoral Neck Fracture After Arthroscopic Femoroplasty of the Hip.

    PubMed

    Merz, Michael K; Christoforetti, John J; Domb, Benjamin G

    2015-08-01

    Hip arthroscopy is an increasingly common procedure, particularly for the treatment of femoroacetabular impingement. Various complications have been previously reported, and the authors sought to further evaluate the safety of this procedure. This study was conducted to identify the incidence of femoral neck fracture as well as treatment and outcomes after arthroscopic femoroplasty. In April 2013, a survey was administered to 28 established hip arthroscopists regarding the breadth of their experience, including the total number of hip arthroscopies and proximal femoroplasties performed and the number of postoperative femoral neck fractures. Fracture type, patient age, patient sex, time to fracture, comorbidities, treatments, and outcomes were queried. The study identified 27,200 total arthroscopies and 14,945 proximal femoroplasties performed by the surgeons, with 11 postoperative proximal femur fractures. The incidence of proximal femur fracture after arthroscopic femoroplasty was 0.07%, based on combined data of high-volume hip arthroscopists at multiple medical centers. Mean time to fracture after arthroscopic femoroplasty was 40.5 (±26.6) days postoperatively. The male-to-female ratio was approximately 1:3 for those with fracture, and mean patient age was 52 (±13) years. More than half of the fractures were caused by violation of weight-bearing precautions. All patients had improvement in symptoms after treatment. Femoral neck fracture after arthroscopic femoroplasty is a rare complication for established hip arthroscopists. It is most common in women and patients older than 50 years. Treatment is based on the severity of the fracture, and patients have improved outcomes after treatment. PMID:26270756

  5. Arthroscopic pancapsular plication for multidirectional shoulder instability in overhead athletes.

    PubMed

    Ma, Hsiao-Li; Huang, Hui-Kuang; Chiang, En-Rung; Wang, Shih-Tein; Hung, Shih-Chieh; Liu, Chein-Lin

    2012-04-01

    Treating shoulder multidirectional instability with an open stabilization procedure has been reported to have good results. However, few studies exist of arthroscopic plication, especially in overhead athletes. The purpose of this study was to evaluate the clinical outcomes of arthroscopic pancapsular plication for multidirectional instability in overhead athletes.Twenty-three athletes with symptomatic multidirectional instability were treated with arthroscopic pancapsular plication and evaluated at a mean follow-up of 36.3 months (range, 24-61 months). Mean patient age was 23.3 years (range, 19-33 years). Functional outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder score, and Rowe instability score. The degree of pain and range of motion were also recorded. All postoperative functional scores were rated good to excellent, with an average ASES score of 88.4 (range, 82-95), average Constant shoulder score of 88.1 (range, 81-100), and average Rowe instability score of 86.7 (range, 80-100). Five patients returned to the same level of competitive sports, and 18 returned to a limited level. All patients were satisfied with the stability postoperatively. No significant change was observed in postoperative range of motion, but patients who returned to a limited level of sports had lower functional scores and more pain than did those who fully returned to sports.Arthroscopic pancapsular plication for treating multidirectional instability in overhead athletes can provide good stability. However, the low rate of return to a full level of overhead sports is a problem. Further evaluation of the benefits of this procedure for overhead athletes with symptomatic multidirectional instability is needed. PMID:22495849

  6. Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus. PMID:26697294

  7. Arthroscopically assisted excision of osteoid osteoma involving the hip.

    PubMed

    Khapchik, V; O'Donnell, R J; Glick, J M

    2001-01-01

    Two cases of arthroscopically assisted excision of osteoid osteoma involving the femoral neck and acetabulum are presented. This technique allows for percutaneous excision of this benign bone lesion in those rare circumstances when it occurs in an intra-articular location. The approach enables direct visualization of the tumor as well as histologic confirmation. There was minimal morbidity, excellent relief of symptoms, and rapid functional restoration. PMID:11154368

  8. The Comprehensive Arthroscopic Management Procedure for Treatment of Glenohumeral Osteoarthritis

    PubMed Central

    Mook, William R.; Petri, Maximilian; Greenspoon, Joshua A.; Millett, Peter J.

    2015-01-01

    Younger, high-demand patients who are less suitable for joint replacement procedures are often affected by advanced glenohumeral osteoarthritis. There are several alternatives to total joint arthroplasty for the treatment of these patients. However, the outcomes of these procedures are less predictable and have limited durability. The comprehensive arthroscopic management procedure, which includes a combination of arthroscopic glenohumeral debridement, chondroplasty, synovectomy, loose body removal, humeral osteoplasty with excision of the goat's beard osteophyte, capsular releases, subacromial and subcoracoid decompressions, axillary nerve decompression, and biceps tenodesis, has been shown to reduce pain, improve function, and provide a predictable short-term joint-preserving option for patients with advanced glenohumeral osteoarthritis. A unique feature of the comprehensive arthroscopic management procedure is the indirect and direct decompression of the axillary nerve, which may explain the difference in outcomes with this technique compared with other approaches. Furthermore, the technique is technically demanding and associated with several notable pitfalls that are preventable when using the meticulous surgical technique detailed in this article and accompanying video. PMID:26697301

  9. Arthroscopic Treatment of Symptomatic Internal Snapping Hip with Combined Pathologies

    PubMed Central

    Hwang, Duck-Soo; Hwang, Jung-Mo; Kim, Pil-Sung; Rhee, Sung-Min; Park, Seung-Hwan; Kang, Soo Yong

    2015-01-01

    Background Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. Methods Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. Results Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. Conclusions Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies. PMID:26217460

  10. Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

    PubMed Central

    Cerlier, Alexandre; Gay, André-Mathieu; Levadoux, Michel

    2015-01-01

    Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. Arthrosynovial cyst resection, ganglion curettage, and bone grafting were performed arthroscopically. Pain had totally disappeared within 2 months after the operation in 100% of patients. The average hand grip strength was estimated at 100% compared with the opposite side, and articular ranges of motion were the same on both sides in 100% of cases. No complications were reported after surgery. On the basis of these results, arthroscopic treatment of intraosseous synovial ganglion cysts seems to be more efficient and helpful in overcoming the limitations of classic open surgery in terms of complications.

  11. Ultrasonography-Assisted Arthroscopic Proximal Iliotibial Band Release and Trochanteric Bursectomy

    PubMed Central

    Weinrauch, Patrick; Kermeci, Sharon

    2013-01-01

    We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression. PMID:24400195

  12. PHYSICAL THERAPY INTERVENTION FOR A FORMER POWER LIFTER AFTER ARTHROSCOPIC MICROFRACTURE PROCEDURE FOR GRADE IV GLENOHUMERAL CHONDRAL DEFECTS

    PubMed Central

    Sum, Jonathan

    2011-01-01

    Background: Power lifting places the shoulder complex at risk for injury. Microfracture is a relatively new procedure for chondral defects of the glenohumeral joint and is not well described in the literature. Objectives: The purpose of this case report is to describe the post-operative rehabilitation used with a power lifter who underwent a microfracture procedure to address glenoid and humeral chondral defects, debridement of type I superior labral anterior-posterior lesion, and a subacromial decompression. Case Description: The patient was a 46 year-old male who was evaluated nine weeks status-post arthroscopic microfracture procedure for glenoid and humeral chondral defects, debridement of superior labral anterior-posterior (SLAP) lesion, and subacromial decompression. Rehabilitation consisted of postural education, manual therapy, rotator cuff and scapular strengthening, dynamic stabilization, weightbearing exercises, and weight training over nine weeks (24 sessions). Lifting modifications were addressed. Outcomes: Results of the QuickDASH indicate that activities of daily living (ADLs), work, and sports modules all improved significantly, and the patient was able to return to recreational power lifting with limited discomfort or restrictions. Discussion: A structured post-operative physical therapy treatment program allowed this patient to return to recreational power lifting while restoring independent function for work-related activities and ADLs. PMID:21655454

  13. Arthroscopic Tenoplasty in Congenital Split Biceps Long Head

    PubMed Central

    Yoo, Yon-Sik; Kim, Hyung-Jin; Arora, Manish

    2014-01-01

    The long head of the biceps brachii tendon arises mainly from the superior glenoid labrum and supraglenoid tubercle. Biceps brachii display anatomic variations, but these are rarely encountered. We report, for the first time, a technique called arthroscopic intra-articular biceps tenoplasty describing restoration of the long head of the biceps tendon using the superior capsule in a case of anomalous congenital split biceps tendon encountered incidentally during diagnostic glenohumeral arthroscopy in a patient who was treated for shoulder instability and SLAP tear. PMID:24904759

  14. Anterior femoroacetabular impingement.

    PubMed

    Laude, Frédéric; Boyer, Thierry; Nogier, Alexis

    2007-03-01

    Anterior femoroacetabular impingement is a mechanical hip disorder defined as abnormal contact between the anterior acetabular rim and the proximal femur. The typical patient is a young man who practices a martial art that involves kicking. Mechanical groin pain is the main presenting symptom. Passive flexion and internal rotation of the hip replicates the pain. The range of internal rotation is often limited. Imaging studies show a non-spherical femoral head or overhang of the anterior acetabular rim. Computed arthrotomography or magnetic resonance arthrography visualize focal damage to the anterosuperior labrum and sometimes to the acetabular cartilage. Discontinuing the activity associated with the harmful hip movement is the main treatment. However, arthroplasty and removal of damaged labral tissue may be required. Surgical outcomes correlate negatively with the severity of the cartilage lesions. PMID:17337228

  15. Superior Labrum Anterior Posterior Lesions and Associated Injuries

    PubMed Central

    Beyzadeoglu, Tahsin; Circi, Esra

    2015-01-01

    Background: Superior labrum anterior posterior (SLAP) lesions often cause shoulder pain, dysfunction, and instability. Professional athletes require a high level of shoulder function for competition and overhead activities. Purpose: To evaluate elite athletes who had arthroscopic surgery for common shoulder pathologies and SLAP lesions with a follow-up of more than 3 years. The associated intra-articular pathologies and return to play were documented. Study Design: Case series; Level of evidence, 4. Methods: Thirty-five shoulders in 34 elite athletes (4 women and 30 men; mean age, 25 years [range, 18-32 years]) had arthroscopic repair of SLAP lesions and accompanying Bankart or rotator cuff tears between January 2008 and November 2011. The documentation included patient symptoms, physical examination, radiological analysis with radiographs, and magnetic resonance imaging. Shoulder function was evaluated preoperatively and at follow-up using American Shoulder and Elbow Surgeons (ASES) and Kerlan Jobe Orthopaedic Clinic (KJOC) scores. The mean follow-up was 52 months. Results: Isolated SLAP lesions were seen in 17.1% of patients, SLAP lesions and partial cuff tear occurred in 25.7%, associated Bankart lesions in 37.1%, full-thickness rotator cuff tears in 8.6%, Bankart and posterior labrum lesions in 8.6%, and Bankart and full-thickness rotator cuff tears in 2.9%. Return to play was a mean 6.4 ± 1.5 months. The mean postoperative ASES and KJOC scores were 89.6 ± 4.6 and 80.9 ± 6.8, respectively, compared with preoperative scores of 64.0 ± 7.2 and 50.5 ± 10.3 (t test, P < .01). Conclusion: The majority (88.2%) of professional athletes returned to their preinjury levels. SLAP lesions may frequently occur with Bankart lesions and rotator cuff tears. A high rate of return to sport at the same level of athletic performance can be achieved by anatomic repair and effective rehabilitation.

  16. Risk factors for shoulder re-dislocation after arthroscopic Bankart repair

    PubMed Central

    2014-01-01

    Background Recent studies have shown effective clinical results after arthroscopic Bankart repair (ABR) but have shown several risk factors for re-dislocation after surgery. We evaluated whether patients are at a risk for re-dislocation during the first year after ABR, examined the recurrence rate after ABR, and sought to identify new risk factors. Methods We performed ABR using bioabsorbable suture anchors in 102 consecutive shoulders (100 patients) with traumatic anterior shoulder instability. Average patient age and follow-up period was 25.7 (range, 14–40) years and 67.5 (range, 24.5–120) months, respectively. We evaluated re-dislocation after ABR using patient telephone interviews (follow-up rate, 100%) and correlated re-dislocation with several risk factors. Results Re-dislocation after ABR occurred in nine shoulders (8.8%), of which seven sustained re-injuries within the first year with the arm elevated at 90° and externally rotated at 90°. Of the remaining 93 shoulders without re-dislocation, 8 had re-injury under the same conditions within the first year. Thus, re-injury within the first year was a risk for re-dislocation after ABR (P < 0.001, chi-squared test). Using multivariate analysis, large Hill-Sachs lesions (odds ratio, 6.77, 95% CI, 1.24–53.6) and <4 suture anchors (odds ratio, 9.86, 95% CI, 2.00–76.4) were significant risk factors for re-dislocation after ABR. Conclusions The recurrence rate after ABR is not associated with the time elapsed and that repair strategies should augment the large humeral bone defect and use >3 anchors during ABR. PMID:24993404

  17. The successful arthroscopic treatment of suprascapular intraneural ganglion cysts.

    PubMed

    Prasad, Nikhil K; Spinner, Robert J; Smith, Jay; Howe, Benjamin M; Amrami, Kimberly K; Iannotti, Joseph P; Dahm, Diane L

    2015-09-01

    OBJECT High-resolution magnetic resonance imaging (MRI) can distinguish between intraneural ganglion cysts and paralabral (extraneural) cysts at the glenohumeral joint. Suprascapular intraneural ganglion cysts share the same pathomechanism as their paralabral counterparts, emanating from a tear in the glenoid labrum. The authors present 2 cases to demonstrate that the identification and arthroscopic repair of labral tears form the cornerstone of treatment for intraneural ganglion cysts of the suprascapular nerve. METHODS Two patients with suprascapular intraneural ganglion cysts were identified: 1 was recognized and treated prospectively, and the other, previously reported as a paralabral cyst, was identified retrospectively through the reinter-pretation of high-resolution MR images. RESULTS Both patients achieved full functional recovery and had complete radiological involution of the intraneural ganglion cysts at the 3-month and 12-month follow-ups, respectively. CONCLUSIONS Previous reports of suprascapular intraneural ganglion cysts described treatment by an open approach to decompress the cysts and resect the articular nerve branch to the glenohumeral joint. The 2 cases in this report demonstrate that intraneural ganglion cysts, similar to paralabral cysts, can be treated with arthroscopic repair of the glenoid labrum without resection of the articular branch. This approach minimizes surgical morbidity and directly addresses the primary etiology of intraneural and extraneural ganglion cysts. PMID:26323813

  18. A minimally invasive medial patellofemoral ligament arthroscopic reconstruction.

    PubMed

    Zhou, Jian-Wei; Wang, Cheng-Hai; Ji, Gang; Ma, Long-Fei; Wang, Juan; Zhang, Feng; Dong, Jiang-Tao; Wang, Fei

    2014-02-01

    The medial patellofemoral ligament reconstruction is recognized as a good choice for patients with recurrent patellar dislocation. Most techniques of the medial patellofemoral ligament reconstruction are open surgeries. Recently, we present a minimally invasive medial patellofemoral ligament arthroscopic reconstruction technique as a possible alternative method for recurrent patellar dislocation. The aim of the study was to describe a safe and effective technique to perform medial patellofemoral ligament reconstruction. The graft was prepared in shape to "Y." Two 5-mm incisions were made in the skin above the medial edge of the patella. Two docking bone tunnels were drilled from medial edge to the center of the patella, mimicking the wide patellar insertion of the medial patellofemoral ligament, and a bone tunnel was made at the femoral insertion site. Two free ends of the graft were fixed into the patellar tunnels by lateral cortical suspension, and the folded end was fixed into the femoral tunnel by bioabsorbable interference screw. Average patellar tilt and the congruence angle were 30.7° ± 7.5° and 52.7° ± 7.3° and were reduced to 12.8° ± 0.9° and 2.3° ± 11.5° after treatment. The Kujala score was increased from 63.0 ± 9.0 to 91.0 ± 7.0. The minimally invasive medial patellofemoral ligament arthroscopic reconstruction in this paper seems to be helpful to increase safe of operation and treatment effect and reduce complications. PMID:23412307

  19. [Synthetic replacement of the anterior cruciate ligament--effects on the remaining ligament structures].

    PubMed

    Zabel, A; Wening, J V; Rehder, U; Langendorff, H U

    1992-01-01

    In a three-dimensional anatomical knee joint model all major ligaments were replaced by six nylon fibers and length-pattern changes registered and computed during motion between 0-140 degree. Then anteromedial, posteromedial and intermedial fibers were replaced by an artificial ligament made from Aramid (one to three bundle prothesis) and length changes of the remaining ligaments investigated. The result revealed a dynamic feed-back with characteristic changes in the posterior and collateral ligaments in comparison to the reference. A synthetic replacement using a one bundle prothesis in the isometic tracking led to disapointing results. Best correlations were achieved mimicking the anatomic situation by use of a three bundle prothesis with nearly no changes in the length pattern of the remaining ligaments. PMID:1569800

  20. The Effects of Femoral Graft Placement on Cartilage Thickness after Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Okafor, Eziamaka C.; Utturkar, Gangadhar M.; Widmyer, Margaret R.; Abebe, Ermias S.; Collins, Amber T.; Taylor, Dean C.; Spritzer, Charles E.; Moorman, C. T.; Garrett, William E.; DeFrate, Louis E.

    2013-01-01

    Altered joint motion has been thought to be a contributing factor in the long-term development of osteoarthritis after ACL reconstruction. While many studies have quantified knee kinematics after ACL injury and reconstruction, there is limited in vivo data characterizing the effects of altered knee motion on cartilage thickness distributions. Thus, the objective of this study was to compare cartilage thickness distributions in two groups of patients with ACL reconstruction: one group in which subjects received a non-anatomic reconstruction that resulted in abnormal joint motion and another group in which subjects received an anatomically placed graft that more closely restored normal knee motion. Ten patients with anatomic graft placement (mean follow-up: 20 months) and 12 patients with non-anatomic graft placement (mean follow-up: 18 months) were scanned using high-resolution MR imaging. These images were used to generate 3D mesh models of both knees of each patient. The operative and contralateral knee models were registered to each other and a grid sampling system was used to make site-specific comparisons of cartilage thickness. Patients in the non-anatomic graft placement group demonstrated a significant decrease in cartilage thickness along the medial intercondylar notch in the operative knee relative to the intact knee (8%). In the anatomic graft placement group, no significant changes were observed. These findings suggest that restoring normal knee motion after ACL injury may help to slow the progression of degeneration. Therefore, graft placement may have important implications on the development of osteoarthritis after ACL reconstruction. PMID:24210473

  1. The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability.

    PubMed

    Solomonow, M; Baratta, R; Zhou, B H; Shoji, H; Bose, W; Beck, C; D'Ambrosia, R

    1987-01-01

    The synergistic action of the ACL and the thigh muscles in maintaining joint stability was studied experimentally. The EMG from the quadriceps and hamstring muscle groups was recorded and analyzed in three separate experimental procedures in which the knee was stressed. The test revealed that direct stress of the ACL has a moderate inhibitory effect on the quadriceps, but simultaneously it directly excites the hamstrings. Similar responses were also obtained in patients with ACL damage during loaded knee extension with tibia subluxation, indicating that an alternative reflex arc unrelated to ACL receptors was available to maintain joint integrity. The antagonist muscles (hamstrings) were clearly demonstrated to assume the role of joint stabilizers in the patient who has a deficient ACL. The importance of an appropriate muscle-conditioning rehabilitation program in such a patient is substantiated. PMID:3618871

  2. Anterior cruciate ligament allograft transplantation. Long-term function, histology, revascularization, and operative technique.

    PubMed

    Nikolaou, P K; Seaber, A V; Glisson, R R; Ribbeck, B M; Bassett, F H

    1986-01-01

    In recent years much effort has been devoted to finding a satisfactory replacement for the injured ACL. None of the reconstruction techniques used in the past can be considered ideal because of their inability to duplicate the complex geometry, structure, and function of the ligament. Current advances in allograft transplantation and cryopreservation have led us to design and implement an experimental model for testing the feasibility of cryopreserved ACL allotransplantation. Groups of dogs were used to evaluate the effect of cryopreservation on ligament strength and to compare the relative performance of both autograft and allograft ACL transplants up to 18 months after implantation. The ligaments were examined mechanically, histologically, and microangiographically. The cryopreservation process and duration of storage had no effect on the biomechanical or structural properties of the ligament. The mechanical integrity of the allografts was similar to that of the autografts, with both achieving nearly 90% of control ligament strength by 36 weeks. Revascularization approached normal by 24 weeks in both autograft and allograft. No evidence of structural degradation or immunological reaction was seen. Based on these results, we believe that a cryopreserved ACL allograft can provide the ideal material for ACL reconstruction. We have outlined a surgical technique for harvesting and implanting this graft clinically. PMID:3777311

  3. Histopathological Evaluation of the Anterior Cruciate Ligament in Patients Undergoing Primary Total Knee Arthroplasty.

    PubMed

    Mont, Michael A; Elmallah, Randa K; Cherian, Jeffrey J; Banerjee, Samik; Kapadia, Bhaveen H

    2016-01-01

    This study assessed gross and histopathological ACL changes in arthritic knees (n=174) undergoing total knee arthroplasty. Histopathological changes were assessed and graded as absent (0), mild (1), moderate (2), or marked (3). These were correlated to demographic and clinical factors, and radiographic evaluations. The ACL was intact in 43, frayed in 85, torn in 15, and absent in 31 knees. Eighty-five percent had histological changes. Overall, there were significant associations between greater age and BMI, and histological changes. Grade IV knees had significantly greater calcium pyrophosphate deposits, microcyst formation, and number of pathologic changes. These correlations may aid decision-making when determining suitability for unicompartmental or bicruciate-retaining arthroplasties, though further studies should correlate these histological findings to mechanical and functional knee status. PMID:26239235

  4. A Comparison of Degradable Synthetic Polymer Fibers for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Tovar, Nick; Bourke, Sharon; Jaffe, Michael; Murthy, N. Sanjeeva; Kohn, Joachim; Gatt, Charles; Dunn, Michael G.

    2009-01-01

    We compared mechanical properties, degradation rates, and cellular compatibilities of two synthetic polymer fibers potentially useful as ACL reconstruction scaffolds: poly(desaminotyrosyl-tyrosine dodecyl dodecanedioate)(12,10), p(DTD DD) and poly(L-lactic acid), PLLA. The yield stress of ethylene oxide (ETO) sterilized wet fibers was 150 ± 22 MPa and 87 ± 12 MPa for p(DTD DD) and PLLA, respectively, with moduli of 1.7 ± 0.1 MPa and 4.4 ± 0.43 MPa. Strength and molecular weight retention were determined after incubation under physiological conditions at varying times. After 64 weeks strength decreased to 20 and 37% of the initial sterile fiber values and MW decreased to 41% and 36% of the initial values for p(DTD DD) and PLLA, respectively. ETO sterilization had no significant effect on mechanical properties. Differences in mechanical behavior may be due to the semicrystalline nature of PLLA and the small degree of crystallinity induced by mesogenic ordering in p(DTD DD) suggested by DSC analysis. Fibroblast growth was similar on 50-fiber scaffolds of both polymers through 16 days in vitro. These data suggest that p(DTD DD) fibers, with higher strength, lower stiffness, favorable degradation rate and cellular compatibility, may be a superior alternative to PLLA fibers for development of ACL reconstruction scaffolds. PMID:19623532

  5. A comparison of radiographic, arthroscopic and histological measures of articular pathology in the canine elbow joint.

    PubMed

    Goldhammer, Marc A; Smith, Sionagh H; Fitzpatrick, Noel; Clements, Dylan N

    2010-10-01

    Validation of radiographic and arthroscopic scoring of joint pathology requires their comparison with histological measures of disease from the same joint. Fragmentation of the medial coronoid process (FMCP) is a naturally occurring disease of the canine elbow joint that results in osteoarthritis, and the objectives of this study were to compare the severity of histopathological changes in the medial coronoid process (MCP) and medial articular synovial membrane with gross radiographic scoring of elbow joint osteophytosis and the arthroscopic assessment of the MCP articular cartilage surface. Radiographic scoring of osteophytosis and the arthroscopic scoring of visual cartilage pathology of the MCP correlated moderately well with the histopathological evaluation of cartilage damage on the MCP and synovial inflammation in the medial part of the joint, but not with bone pathology in the MCP. Marked cartilage pathology on the MCP was identified in joints with either no radiographic evidence of osteophytosis or with mild cartilage damage that was evident arthroscopically. PMID:19716324

  6. Posterior cruciate ligament balancing in total knee arthroplasty: a numerical study with a dynamic force controlled knee model

    PubMed Central

    2014-01-01

    Background Adequate soft tissue balancing is a key factor for a successful result after total knee arthroplasty (TKA). Posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia after cruciate retaining TKA and is also responsible for the amount of joint compression. However, it is complex to quantify the amount of ligament release with its effects on load bearing and kinematics in TKA and limited both in vivo and in vitro. The goal of this study was to create a dynamic and deformable finite element model of a full leg and analyze a stepwise release of the PCL regarding knee kinematics, pressure distribution and ligament stresses. Methods A dynamic finite element model was developed in Ansys V14.0 based on boundary conditions of an existing knee rig. A cruciate retraining knee prosthesis was virtually implanted. Ligament and muscle structures were simulated with modified spring elements. Linear elastic materials were defined for femoral component, inlay and patella cartilage. A restart algorithm was developed and implemented into the finite element simulation to hold the ground reaction force constant by adapting quadriceps force. After simulating the unreleased PCL model, two models were developed and calculated with the same boundary conditions with a 50% and 75% release of the PCL stiffness. Results From the beginning of the simulation to approximately 35° of flexion, tibia moves posterior related to the femur and with higher flexion anteriorly. Anterior translation of the tibia ranged from 5.8 mm for unreleased PCL to 3.7 mm for 75% PCL release (4.9 mm 50% release). A decrease of maximum von Mises equivalent stress on the inlay was given with PCL release, especially in higher flexion angles from 11.1 MPa for unreleased PCL to 8.9 MPa for 50% release of the PCL and 7.8 MPa for 75% release. Conclusions Our study showed that dynamic FEM is an effective method for simulation of PCL balancing in knee arthroplasty. A tight PCL led in silico to more anterior tibia translation, a higher collateral ligament and inlay stress, while retropatellar pressure remained unchanged. Surgeons may take these results in vivo into account. PMID:24990257

  7. Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl

    PubMed Central

    Koide, Masashi; Tojo, Yuichi; Hagiwara, Yoshihiro; Nakajima, Souichi; Tanaka, Minoru; Honda, Masahito; Itoi, Eiji

    2015-01-01

    Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)). PMID:26713167

  8. All-Arthroscopic Technique for Reconstruction of Acute Acromioclavicular Joint Dislocations

    PubMed Central

    Cutbush, Kenneth; Hirpara, Kieran M.

    2015-01-01

    Acromioclavicular joint dislocations are a common injury particularly among contact sports players. There has been an increasing trend toward arthroscopic management of these injuries. To date, these reconstructions have primarily addressed superoinferior instability by reconstructing the coracoclavicular ligaments. We describe an all-arthroscopic technique for reconstruction of the coracoclavicular ligaments using Arthrex ABS TightRopes (Arthrex, Naples, FL), with additional stabilization of the superior acromioclavicular joint capsule using an anchor-based suture bridge to address anteroposterior instability. PMID:26697307

  9. Anterior segment fluorescein cineangiography.

    PubMed

    Kottow, M H; Jednock, N; Sewell, J H

    1978-03-01

    We have developed a technique for performing anterior segment fluorescein cineangiography. Illumination is obtained with a halogen lamp of a standard slide projector that is fitted with a blue excitation filer. Cinematography occurs with a movie camera fitted with an absorption-type barrier filter and mounted to a photo slit lamp through a cineadapter. The technique has been successfully employed with animals, and it is anticipated that the light levels used are tolerable and safe for application with humans. PMID:306767

  10. Arthroscopic Transfer of the Long Head of the Biceps Tendon

    PubMed Central

    Taylor, Samuel; Baret, Nikolas J.; Newman, Ashley; Delos, Demetris; Drakos, Mark; Copple, Zachary M.; DiPietro, James R.; O'Brien, Stephen J.

    2013-01-01

    Objectives: Evaluation of the mid-term clinical and functional outcome in a cohort of patients who underwent transfer of the long head of the biceps tendon (LHBT). Methods: Patients diagnosed with biceps instability or related pathology that underwent arthroscopic assisted or all arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon were considered. The procedure was performed either as an isolated procedure on in conjunction with another procedure by the senior author. Outcome surveys were collected for 157 patients with a subset of 43 patients available for clinical examination at 2-10 years postop time point. Outcome measures were based on American Society of Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA), and L’Insalata questionnaires. Ipsilateral and contralateral metrics were also evaluated. Results: 157 patients (25 female, 132 male; average age 50 years; average postop 4.9 years) were evaluated with L’Insalata, UCLA, and ASES questionnaires, scoring 84.78, 29.77, and 83.4, respectively. In the 33 patients who had an isolated LHBT transfer, the L’Insalata, UCLA, and ASES scores were 79.52, 27.6, and 83.95, respectively. 43 shoulders (7 female, 36 male; average age 50 years; average postop 5.1 years) were available for clinical examination by a physician other than the treating surgeon. There was no statistically significant side-to- side strength difference using a 10-pound weight. All of the patients reported no arm pain at rest with regard to the biceps. 81% of patients reported no biceps tenderness upon palpation of the bicipital groove and 85.8% had a negative throwing test. 95.2% of patients had a negative active compression test. Speed’s and Yergason’s tests were negative in 90.5% and 95.2% of patients respectively. One patient (3%) complained of fatigue discomfort (soreness) isolated to the biceps muscle following resisted elbow flexion. Five patients (12.0%) had a Popeye sign and one patient (3%) exhibited biceps subsidence. 86% of patients were self-rated as good to excellent, with the remaining 14% reporting fair or poor results. Conclusion: Arthroscopic subdeltoid transfer of the LHBT to the conjoint tendon is an appropriate and reliable intervention for active patients with chronic, refractory biceps pathology. There was no loss of strength for biceps curls. All patients reported no pain isolated to biceps muscle at rest. Ninety-seven percent of patients had resolution of their preoperative biceps symptoms.

  11. Arthroscopic Decompression of Central Acetabular Impingement With Notchplasty

    PubMed Central

    Gupta, Asheesh; Redmond, John M.; Hammarstedt, Jon E.; Stake, Christine E.; Liu, Yuan; Domb, Benjamin G.

    2014-01-01

    Acetabular notch osteophytes are often encountered during routine diagnostic arthroscopy of the hip. It has been our observation that when notch osteophytes are present, there is often corresponding chondral damage to the anterosuperior femoral head and ligamentum teres degeneration. We propose that removal of the notch osteophyte and decompression of the articulating surface offer an effective method of delaying the progression of arthritis. This article describes in detail the technique used to perform arthroscopic acetabular notchplasty, and a companion video, demonstrating the procedure, is included. Our experience suggests that decompression of the acetabular notch can remove offending structural abnormalities that can potentially cause further chondral damage and may hasten the progression of arthritis. PMID:25473605

  12. Arthroscopic Reduction of Complex Dorsal Metacarpophalangeal Dislocation of Index Finger

    PubMed Central

    Kodama, Akira; Itotani, Yuji; Mizuseki, Takaya

    2014-01-01

    Complex dorsal dislocation of the metacarpophalangeal joint is an uncommon injury, typically caused by entrapment of the volar plate within the joint space. Closed reduction of the dislocation is not effective; instead, open reduction is necessary to release the soft tissues interposed between the metacarpal head and the proximal phalanx. However, an operative risk of digital nerve injury exists because of intricate displacement of the normal anatomy. We successfully reduced a dislocation by arthroscopic release of the entrapped volar plate. The case involved an 11-year-old boy with a complex dorsal dislocation of the metacarpophalangeal joint of the right index finger that had failed closed reduction. This technique allowed for reliable joint reduction, enabling observation of the structures obstructing the reduction; was less invasive; and avoided the risk of neurovascular injury. It is a reasonable method to use when the volar plate prevents reduction of the dislocation. PMID:24904773

  13. Return to sport after arthroscopic meniscectomy on stable knees

    PubMed Central

    2013-01-01

    Background Athletes suffering from any injuries want to know when they will be able to return sports activity. The period of return-to-sport after the arthroscopic meniscectomy is still unknown. The aim of this study is to investigate the period of the return-to-sport from surgery and the clinical symptoms after the meniscectomy on stable knees. Methods Fifty-six athletes who underwent the arthroscopic meniscectomy were evaluated. The patients with an average age of 26.7 years (range, 13–67) comprised 45 men and 11 women, 16 medial meniscus and 40 lateral meniscus injuries. The average of the follow-up period was 9.2 months. The parameter examined were age, the injured side of meniscus (medial or lateral), articular cartilage status, amount of resection, and sports activity level. Results The mean period was 54 days in young group, and was 89 days in old group (p?=?0.0013). The period was 79 days in medial meniscus (MM) injured group, and was 61 days in lateral meniscus (LM) group (p?=?0.017). There was a significant difference among the groups in activity levels and in amount of resection. Pain and/or effusion in the knee after the return-to-sport were found 22% of the MM group and 53% in the LM group. Conclusions The period of the return-to-sport was shorter in young age, high activity and large amount of resection group. Although athletes in LM group can return to sports earlier than those in MM group, more than half of athletes have pain or effusion at the time of return-to sport. PMID:24257295

  14. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries. PMID:17350782

  15. Tibialis Anterior Tendon Transfer.

    PubMed

    Mulhern, Jennifer L; Protzman, Nicole M; Brigido, Stephen A

    2016-01-01

    Tendon transfer procedures are used commonly for the correction of soft tissue imbalances and instabilities. The complete transfer and the split transfer of the tibialis anterior tendon are well-accepted methods for the treatment of idiopathic equinovarus deformity in children and adults. Throughout the literature, complete and split transfer have been shown to yield significant improvements in ankle and foot range of motion and muscle function. At present, there is insufficient evidence to recommend one procedure over the other, although the split procedure has been advocated for consistently achieving inversion to eversion muscle balance without overcorrection. PMID:26590723

  16. Evaluation of Skills in Arthroscopic Training Based on Trajectory and Force Data

    PubMed Central

    Tashiro, Yasutaka; Nakanishi, Yoshitaka; Okazaki, Ken; Iwamoto, Yukihide

    2008-01-01

    Objective evaluation of surgical skills is essential for an arthroscopic training system. We asked whether a quantitative assessment of arthroscopic skills using scores, time to completion, instrument tip trajectory data, and force data was valid. We presumed more experienced surgeons would perform better on a simulated arthroscopic procedure than novices, therefore validating the quantitative assessment. Surgical trainees (n = 12), orthopaedic residents (n = 12), and experienced arthroscopic surgeons (n = 6) were tested on a Sawbones® knee simulator. Subjects performed a joint inspection and probing task and a partial meniscectomy task. The trajectory data were measured using an electromagnetic motion tracking system and the force data were measured using a force sensor. The experienced group performed both tasks with higher scores and more quickly than the less experienced groups. The path length of the probe and the scissors was substantially shorter and the probe velocity was considerably faster in the experienced group. The trainee group applied substantially stronger forces to the joint during the joint inspection and probing task. Our data suggest a performance assessment using an electromagnetic motion tracking system and a force sensor provides an objective means of evaluating surgical skills in an arthroscopic training system. PMID:18791774

  17. Diagnosis and management of superior labral anterior posterior tears in throwing athletes.

    PubMed

    Knesek, Michael; Skendzel, Jack G; Dines, Joshua S; Altchek, David W; Allen, Answorth A; Bedi, Asheesh

    2013-02-01

    Injury to the superior glenoid labrum is increasingly recognized as a significant source of shoulder pain and dysfunction in the throwing athlete. Several theories have been proposed to explain the pathogenesis of superior labral anterior posterior (SLAP) tears. The clinical examination of the superior labrum-biceps tendon complex remains challenging because of a high association of other shoulder injuries in overhead athletes. Many physical examination findings have high sensitivity and low specificity. Advances in soft tissue imaging such as magnetic resonance arthrography allow for improved detection of labrum and biceps tendon lesions, although correlation with history and physical examination is critical to identify symptomatic lesions. Proper treatment of throwers with SLAP tears requires a thorough understanding of the altered biomechanics and the indications for nonoperative management and arthroscopic treatment of these lesions. PMID:23172004

  18. A model of articular cruciate ligament reconstructive surgery: a validation construct and computational insights.

    PubMed

    Salehghaffari, Shahab; Dhaher, Yasin Y

    2014-05-01

    This study sought to develop a computational framework that emulates the articular cruciate ligament reconstruction surgery using transtibial portal technique. The proposed model included the tibia-femoral and patella-femoral joints, articular cartilage and menisci. Key surgical parameters were incorporated including bone-patellar-tendon-bone graft excision and pre-tensioning, tunnel morphology, bone plugs, and bone plug fixation. Several simulation steps were parameterized to reflect the clinically reported surgical procedure. Our focus was to explore the intra-operative effects of variations in tunnel directions on the selected metrics of joint mechanics during Lachman and Anterior Drawer tests. A mathematical construct capable of transforming the limited and heterogeneous experimental and surgical data to evidence-based validation was adopted to ensure the viability of the finite element models. We found that the proposed models, subject to a variation in tunnel directions, resulted in simulation outputs that favor the reported experimental data of Lachman and Anterior Drawer tests under uncertainty. Simulation results for a population of three-dimensional tunnel orientations provided insights into the graft-tunnel contact mechanics and the spatial stress distribution in the graft, insights that have been anecdotally observed in prior experimental studies. The intraarticular graft tension was found to be higher than the estimated in tunnel graft force, and larger differences were found for the least inclined tunnels exhibiting higher contact pressures, transverse bending and twisting of the graft and Von-Mises stress at the graft-femoral tunnel interface. Conversely, tunnels with high inclination angles exhibited higher intraarticular graft tension and Von-Mises stress at the graft-tibial bone plug interface. PMID:24690279

  19. Arthroscopic Technique of Capsular Plication for the Treatment of Hip Instability

    PubMed Central

    Chandrasekaran, Sivashankar; Vemula, S. Pavan; Martin, Timothy J.; Suarez-Ahedo, Carlos; Lodhia, Parth; Domb, Benjamin G.

    2015-01-01

    Atraumatic instability or microinstability of the hip is a recognized cause of groin pain and hip instability. Risk factors include female sex, ligamentous laxity, and borderline dysplasia. Arthroscopically, the joint may distract easily, and there may be associated ligamentum teres tears and laxity of the capsule on manual probing. The use of arthroscopic capsular plication in this cohort of patients has shown good to excellent results. Biomechanically, a capsular plication aims to create an imbrication and inferior shift of the capsule to augment the screw-home mechanism of the capsuloligamentous structures and thereby improve stability in extension and external rotation. The purpose of this article is to detail the step-by-step surgical technique of arthroscopic capsular plication, in addition to the indications, pearls, and pitfalls of the technique. PMID:26052494

  20. Surgical interventions for anterior shoulder instability in rugby players: A systematic review

    PubMed Central

    Sabharwal, Sanjeeve; Patel, Nirav K; Bull, Anthony MJ; Reilly, Peter

    2015-01-01

    AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability. METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubMed, EMBASE and Google Scholar using the following search terms: “rugby” and “shoulder” in combination with “instability” or “dislocation”. All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined. RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4 (poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 mo. CONCLUSION: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects. PMID:25992318

  1. The biomechanics of the knee following injury and reconstruction of the posterior cruciate ligament c Louis DeFrate.

    E-print Network

    DeFrate, Louis E., 1977-

    2005-01-01

    Very little is known regarding the function of the posterior cruciate ligament in response to physiological loading conditions. A limited understanding of posterior cruciate ligament function might contribute to the poor ...

  2. Arthroscopic biceps tendon tenodesis: the anchorage technical note.

    PubMed

    Castagna, A; Conti, M; Mouhsine, E; Bungaro, P; Garofalo, R

    2006-06-01

    Treatment of long head biceps (LHB) tendon pathology has become an area of renewed interest and debate among orthopaedic surgeons in recent years. The background of this manuscript is a description of biceps tenodesis which ensure continual dynamic action of the tendon which depresses the head and impedes lateral translation. A new technique has been developed in order to treat LHB tendon irreversible structural abnormalities associated with cuff rotator lesions. This technique entails the construction of a biological anchor between the LHB and supraspinatus and/or infraspinatus tendons according to arthroscopic findings. The rationale, although not supported by biomechanical studies is to obtain a triple, biomechanical effect. The first of these biomechanical effects which we try to promote through the procedure of transposition is the elimination of the deviation and oblique angle which occurs as the LHB completes its intra-articular course prior to reaching the bicipital groove. Furthermore, we have found this technique extremely useful in the presence of large ruptures of the rotator cuff with muscle retraction. The most common complication associated to this particular method, observed in less than 3%, is failed biological fixation which manifests as subsidence of the tenodesis and consequent descent of the tendon with evident aesthetic deformity. PMID:16374589

  3. Arthroscopic lens distortion correction applied to dynamic cartilage loading.

    PubMed

    Kallemeyn, Nicole A; Grosland, Nicole M; Magnotta, Wincent A; Martin, James A; Pedersen, Douglas R

    2007-01-01

    It is difficult to study the deformation of articular cartilage because it is an inhomogenous material with depth dependent constituents. In many experimental studies, cartilage is assumed to behave homogeneously and is subjected to only static or quasi-static loads. In this study, a thick walled, mechanically active culture device (TRIAX) was used to apply cyclic loading to cartilage explants at physiological stress levels. An arthroscope was fitted into the wall of the TRIAX to monitorand record the cyclic compressive behavior of the cartilage and to measure depth dependent cartilage strains. A common concern with arthroscopy systems is that the images obtained are radially distorted about a central point ("fisheye" view); therefore it is necessary to correct this distortion in order to accurately quantify distances between objects within the images. To do this, an algorithm was developed which used a calibration pattern to create an image transform. Digital video of the cyclic cartilage compression was recorded, and the distortion algorithm was applied to the images to measure the cartilage as it deformed. This technique will provide valuable and practical insight into cartilage mechanics and viability (via calcein AM-stained chondrocytes) during multiday cyclic loading of living cartilage explants. The implementation of an arthroscopy system provides the advantage of bringing microscope-level resolution into a cartilage compression device to allow for digital visualization of the entire explant at the whole-tissue level. PMID:17907430

  4. Arthroscopic Resection of Intra-Articular Osteochondromas of the Hip

    PubMed Central

    Aguiar, Thiago; Dantas, Pedro

    2014-01-01

    Proximal femur osteochondromas are relatively rare, particularly in the femoral neck. The choice of treatment poses difficulties to the surgeon. We report an unusual case of a patient with 2 osteochondromas in the femoral neck causing femoroacetabular impingement. Appropriate identification and precise resection of the lesions are important steps of the surgical procedure. We present our arthroscopic surgical technique to access the lesions and perform their resection. To our knowledge, this is the first report of hip arthroscopic resection of 2 osteochondromas with considerable dimensions causing femoroacetabular impingement. PMID:25126501

  5. Arthroscopic First Metatarsophalangeal Arthrodesis for Repair of Fixed Hallux Varus Deformity.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Arthroscopic first metatarsophalangeal arthrodesis for fixed hallux varus deformity can be very difficult because narrowing of the medial joint space results in difficult access. The abductor hallucis tendon and the medial capsule can be released through a small proximal plantar medial incision. This will convert the deformity into a flexible one and open up the medial joint space. This allows arthroscopic arthrodesis using the standard dorsolateral and medial portals. The plantar medial incision can also be used for arthroscopy of the metatarsosesamoid compartment and insertion of a screw for first metatarsophalangeal arthrodesis. PMID:26319187

  6. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  7. [Replacement of the anterior cruciate ligament by cold preserved bone-cruciate ligament-bone allotransplants. An experimental study in the sheep].

    PubMed

    Jaskulka, R; Ittner, G; Birkner, T

    1997-09-01

    One ACL in each of 17 mature sheep was replaced with a deep-frozen bone-an ACL bone allograft. Allografts were obtained from skeletally mature sheep using a standard aseptic technique and stored deep frozen for at least 6 days (mean 21 days). Macroscopical, biomechanical, and histological changes were evaluated 12, 24, and 52 weeks following implantation. At autopsy all allograft ligaments were present and demonstrated no evidence of infection or immune reaction. We found slight arthrotic changes in 3 knees after 12 weeks, in 4 knees after 24 weeks, and in 3 knees after 52 weeks. Twelve weeks after the operation the maximum load of the allografts was 17.5% of the contralateral controls and increased to 20.9% after 24 weeks and to 32% of controls after 52 weeks. Ligament stiffness in the linear region also increased from 18.9% of control (12 weeks) to 32.5% after 52 weeks, whereas maximum load decreased from 112.2% of controls (12 weeks) to 98% of controls (52 weeks). Histologically, the allografts progressively matured with time, becoming nearly identical to normal ligaments at 52 weeks. PMID:9411800

  8. Multiple Looping Technique for Tibial Fixation in Posterior Cruciate Ligament Reconstruction of the Knee

    PubMed Central

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak; Lee, Jae Woo

    2015-01-01

    The outcomes of posterior cruciate ligament reconstruction may be negatively affected by insufficient tibial tunnel fixation due to relatively lower bone density of the proximal tibia. We introduce a new technique of tibial fixation for posterior cruciate ligament reconstruction using free tendon Achilles allograft that is less affected by the bone density of the tibial metaphysis. PMID:25973367

  9. Editorial Commentary: Arthroscopic-Assisted Treatment of Ankle Fractures Could Have Benefits That Outweigh the Risks.

    PubMed

    Lubowitz, James H

    2015-11-01

    Review of ankle arthroscopy, as an adjunct during ankle fracture open reduction and internal fixation, suggests that the benefits may outweigh the risks, because cartilage injury and other soft-tissue pathology amenable to arthroscopic treatment are common in patients with fracture of the ankle. PMID:26542204

  10. Arthroscopic contact Nd:YAG laser meniscectomy: basic science, surgical technique, and clinical follow up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Fealy, Stephen V.; Gibney, Mary A.; Miller, Drew V.; Kelly, Anne M.

    1990-06-01

    Recent basic science studies (5) have provided a scientific foundation for the use of the Contact Nd:YAG Laser as an arthroscopic tool for xneniscal resection and acroxnioplasty of the shoulder in a saline medium. This study prospectively evaluates the results of a three stage laboratory investigation as well as the clinical results of arthroscopic xneniscal resection. Fifteen patients with meniscal tears underwent subtotal meniscectomies utilizing a Contact Nd:YAG Laser (Surgical Laser Technologies; Malvern, Pennsylvania) . This was done in a saline medium with an average laser wattage of 25 W, (range 20 W to 30 W). Patients were evaluated postoperatively with reference to subjective and objective parameters at one week and four weeks postoperatively. Patients were evaluated with regard to wound healing, intraarticular swelling and pain. Assessment of technical parameters such as ease of resection, time of resection and instrument access were compared to conventional instruments. All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing and swelling. In addition, although there was increased time with setting up the laser and calibrating it, there was not an increase in time for meniscal resection. Little, or no, secondary "trimmuning" was necessary with the laser. Increased accessibility was noted due to the small size of the laser. Arthroscopic Contact Nd:YAG Laser surgery is a safe and effective tool for menisca]. resection and coagulation in arthroscopic acromioplasties. It provides significant advantages over conventional cutting instruments with regard to accessibility and reduced need for secondary instruments.

  11. Arthroscopic repair of peripheral triangular fibrocartilage complex tears with suture welding: a technical report.

    PubMed

    Badia, Alejandro; Jiménez, Alexis

    2006-10-01

    This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage complex tears that replaces traditional suture knots with ultrasonic welding of sutures. This will help eliminate potential causes of ulnar-sided wrist discomfort during the postoperative period. PMID:17027791

  12. Arthroscopic treatment of osteochondral lesions of the talus: microfracture and drilling versus debridement.

    PubMed

    Backus, Jonathon D; Viens, Nicholas A; Nunley, James A

    2012-01-01

    Operative treatment of osteochondral lesions of the talus (OLTs) is frequently based on lesion size, stability, and surgeon preference. The purpose of this study was to determine if one arthroscopic treatment is superior to another for improving pain in patients with OLTs. Sixty-two patients treated by a single surgeon from 1999 to 2009 had sufficient medical records to be reviewed. Demographics, mechanism of injury, type of operation, lesion characteristics, and pain scores were analyzed. Thirty-one males and 31 females (mean age 32) were included; 54.1% of the lesions were on the medial talar dome and 72.3% were posttraumatic. Seventeen patients underwent arthroscopic debridement and 45 underwent arthroscopic drilling or microfracture. Visual analog scale pain scores were documented in 33 patients, demonstrating a statistically significant decrease at 6 months for debridement (p = .006) and drilling and microfracture (p = .0003) procedures. Neither procedure was superior to the other in pain reduction. No demographic variables were identified that influenced these postoperative pain scores. These results support that most OLTs are posttraumatic lesions caused by inversion or twisting and often occur on the medial talus. Arthroscopic interventions were effective for decreasing pain in both surgical groups. PMID:23327846

  13. Arthroscopic decompression of paralabral cyst around suprascapular notch causing suprascapular neuropathy

    PubMed Central

    Gupta, Ravi; Kapoor, Love; Shagotar, Saurabh

    2015-01-01

    A case of 22 year old male gymnast, who suffered from suprascapular neuropathy due to compression of suprascapular nerve by paralabral cysts around suprascapular notch, leading to marked atrophy of supraspinatus and infraspinatus muscles. After arthroscopic decompression of paralabral cysts, weakness and atrophy of the supraspinatus and infraspinatus muscles improved. PMID:26155054

  14. Modeling Arthroscopic Camera with Haptic Devices in Image-based Virtual Environments

    E-print Network

    Sourin, Alexei

    Singapore ABSTRACT Minimally invasive arthroscopic surgery has become the gold standard for orthopaedic surgery procedures on joints. It is done by making small incisions on the skin through which special]: Three-Dimensional Graphics and Realism ­ virtual reality. 1 INTRODUCTION Many orthopaedic surgery

  15. Degenerative changes of the cranial cruciate ligament harvested from dogs with cranial cruciate ligament rupture

    PubMed Central

    ICHINOHE, Tom; KANNO, Nobuo; HARADA, Yasuji; YOGO, Takuya; TAGAWA, Masahiro; SOETA, Satoshi; AMASAKI, Hajime; HARA, Yasushi

    2015-01-01

    Degenerative cranial cruciate ligament (CCL) rupture is characterized histologically by degenerating extracellular matrix (ECM) and chondroid metaplasia. Here, we describe the progression of chondroid metaplasia and the changes in the expression of ECM components in canine CCL rupture (CCLR). CCLs from 26 stifle joints with CCLR (CCLR group) and normal CCLs from 12 young beagles (control group) were examined histologically and immunohistochemically for expression of type I (COLI), type II (COLII), type III collagen (COLIII) and Sry-type HMG box 9 (SOX9). Cell density and morphology of CCLs were quantified using hematoxylin–eosin staining. The percentage of round cells was higher in the CCLR group than in controls. COLI-positive areas were seen extensively in the connecting fibers, but weakly represented in the cytoplasm of normal CCLs. In the CCLR group, there were fewer COLI-positive areas, but many COLI-positive cells. The percentages of COLII-, COLIII- and SOX9-positive cells were higher in the CCLR group than in controls. The number of spindle cells with perinuclear halo was high in the CCLR group, and most of these cells were SOX9-positive. Deposition of COLI, the main ECM component of ligaments, decreased with increased COLIII expression in degenerated CCL tissue, which shows that the deposition of the ECM is changed in CCLR. On the contrary, expression of SOX9 increased, which may contribute to the synthesis of cartilage matrix. The expression of COLII and SOX9 in ligamentocytes showed that these cells tend to differentiate into chondrocytes. PMID:25716871

  16. Degenerative changes of the cranial cruciate ligament harvested from dogs with cranial cruciate ligament rupture.

    PubMed

    Ichinohe, Tom; Kanno, Nobuo; Harada, Yasuji; Yogo, Takuya; Tagawa, Masahiro; Soeta, Satoshi; Amasaki, Hajime; Hara, Yasushi

    2015-07-01

    Degenerative cranial cruciate ligament (CCL) rupture is characterized histologically by degenerating extracellular matrix (ECM) and chondroid metaplasia. Here, we describe the progression of chondroid metaplasia and the changes in the expression of ECM components in canine CCL rupture (CCLR). CCLs from 26 stifle joints with CCLR (CCLR group) and normal CCLs from 12 young beagles (control group) were examined histologically and immunohistochemically for expression of type I (COLI), type II (COLII), type III collagen (COLIII) and Sry-type HMG box 9 (SOX9). Cell density and morphology of CCLs were quantified using hematoxylin-eosin staining. The percentage of round cells was higher in the CCLR group than in controls. COLI-positive areas were seen extensively in the connecting fibers, but weakly represented in the cytoplasm of normal CCLs. In the CCLR group, there were fewer COLI-positive areas, but many COLI-positive cells. The percentages of COLII-, COLIII- and SOX9-positive cells were higher in the CCLR group than in controls. The number of spindle cells with perinuclear halo was high in the CCLR group, and most of these cells were SOX9-positive. Deposition of COLI, the main ECM component of ligaments, decreased with increased COLIII expression in degenerated CCL tissue, which shows that the deposition of the ECM is changed in CCLR. On the contrary, expression of SOX9 increased, which may contribute to the synthesis of cartilage matrix. The expression of COLII and SOX9 in ligamentocytes showed that these cells tend to differentiate into chondrocytes. PMID:25716871

  17. Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques.

    PubMed

    Hamai, Satoshi; Okazaki, Ken; Shimoto, Takeshi; Nakahara, Hiroyuki; Higaki, Hidehiko; Iwamoto, Yukihide

    2015-05-01

    In this study, we evaluated the in vivo kinematics of stair-climbing after posterior stabilized (PS) and cruciate retaining (CR) total knee arthroplasty (TKA) using radiographic-based image-matching techniques. Mid-flexion anteroposterior stability was demonstrated in all knees after CR TKA. However, paradoxical femoral translation at low flexion angles was seen in both designs. The post-cam mechanism did not function after PS TKA. Larger posterior tibial slope in PS TKA was linked to forward sliding of the femur at mid-flexion and unintended anterior tibial post impingement at knee extension. CR TKA is more sagittally stable in mid-flexion during stair climbing and attention must be given to minimize posterior tibial slope when using late cam-post engaging PS TKA designs. PMID:25618811

  18. Anterior urethroplasty--changing concepts.

    PubMed

    Motiwala, H G; Visana, K N; Joshi, S P; Patel, P C

    1992-01-01

    The management of complex anterior urethral strictures, not amendable to dilatation or internal urethromotomy, is difficult. Our experience of treating long strictures of anterior urethra with one-stage urethroplasty in 16 cases and two-stage Johanson's in 12 cases are reviewed here. The strictures had varied etiology and many were associated with fistula, diverticulum, etc. Three cases had concomitant posterior urethral strictures and were managed by one-stage anterior and posterior urethroplasty simultaneously. The one-stage repair was done using vascularized flap of longitudinal ventral penile skin in most cases. Transverse scrotal flap and Duckket's transverse preputial flap were utilized in 2 cases each. In one-stage repair success was 100% and in two-stage repair it was 75%. Our preference is now for one-stage repair irrespective of length and number of strictures. PMID:1589924

  19. Arthroscopic fixation with intra-articular button for tibial intercondylar eminence fractures in skeletally immature patients.

    PubMed

    Memisoglu, Kaya; Muezzinoglu, Umit S; Atmaca, Halil; Sarman, Hakan; Kesemenli, Cumhur C

    2016-01-01

    The aim of this study was to describe our experiences with arthroscopy-guided intra-articular button fixation in the treatment of displaced tibial eminence fractures in skeletally immature children. Eleven adolescent patients with an average age of 12.2 years were treated arthroscopically between January 2005 and February 2007. At follow-up evaluation at 69 months, we did not find any instability. Only minimal differences were found in the functional outcomes (Lysholm and International Knee Documentation Committee scores: 95.7 and 94.3, respectively). None of the patients had a leg-length discrepancy defined at the time of the final follow-up. The advantages of this technique are as follows: (a) it is a simple and reliable arthroscopic technique with a direct view, (b) the fixation is stable, PMID:26340367

  20. Arthroscopic treatment of chronically painful calcific tendinitis of the rectus femoris

    PubMed Central

    2013-01-01

    Background Relatively large calcific tendinitis with persistent symptoms after extended periods of conservative treatment is an indication for operative therapy. Arthroscopy, as a treatment for calcific tendinitis of the hip abductors and calcinosis circumscripta, has been described previously; however, to our knowledge, the clinical and radiological response to arthroscopic removal of calcific tendinitis of the rectus femoris tendon has not. Methods We present arthroscopic treatment of unusual calcific tendonitis of the origin of the rectus femoris and associated intra-articular lesions in 3 patients with chronic coxa pain. Results Our cases show that hip arthroscopy is an effective therapeutic modality for calcific tendinitis of the hip joint with satisfactory short-term outcomes. Conclusions Calcific tendinitis, although an uncommon clinical entity, should be a part of the differential diagnosis of acute or chronic hip pain. PMID:24266900

  1. Arthroscopic contact Nd:YAG laser meniscectomy: surgical technique and clinical follow-up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Miller, Drew V.; Fealy, Stephen V.; Gibney, Mary A.; Kelly, Anne M.

    1991-05-01

    Fifteen patients were studied prospectively as a pilot study to evaluate the safety and efficacy of the contact Neodynium: Yttrium Aluminum Garnet (Nd:YAG) laser in performing arthroscopic meniscal resection in a saline medium, (Surgical Laser Technologies; Malverne, PA). All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing, and post-operative swelling. Although there was increased time involved with setting up and calibrating the laser, there was not an increase in time for meniscal resection. In addition, the decreased need for secondary trimming and increased accessibility to the posterior horns of the menisci represent advantages over conventional instruments. Based on the findings, arthroscopic contact Nd:YAG laser surgery is a safe and effective clinical tool for meniscal resection which may, with increased technological advancements and cost reduction, replace standard instrumentation.

  2. Arthroscopic Microfracture Technique for Cartilage Damage to the Lateral Condyle of the Tibia

    PubMed Central

    Kan, Hiroyuki; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Minami, Ginjiro; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2015-01-01

    This report describes the use of arthroscopic microfracture to treat a 10-year-old female patient with extensive damage to the cartilage of the lateral condyle of the tibia before epiphyseal closure, resulting in good cartilage recovery. Magnetic resonance imaging showed a defect in part of the load-bearing surface of the articular cartilage of the condyle articular of the tibia. The patient was diagnosed with damage to the lateral condyle cartilage of the tibia following meniscectomy, and arthroscopic surgery was performed. The cartilage defect measured approximately 20 × 20?mm, and microfracture was performed. Arthroscopy performed four months postoperatively showed that the cartilage defect was completely covered with fibrous cartilage, and the patient was allowed to resume sports activities. Four years postoperatively, she has had no recurrence of pain or hydrarthrosis. PMID:26345523

  3. Arthroscopic direct repair for radial tear of the triangular fibrocartilage complex.

    PubMed

    Cho, Chul-Hyun; Lee, Young-Kuk; Sin, Hong-Kwan

    2012-01-01

    Although various repair techniques for Palmer type 1B lesions of the triangular fibrocartilage complex (TFCC) have been introduced, arthroscopic repair techniques for Palmer type 1D lesions are still being honed. Until recently, inside-out techniques have commonly been used to repair radial tears of the TFCC. However, that technique has the disadvantages of a requirement for an extra skin incision, pain resulting from prominent subcutaneous suture knot stacks, and peripheral nerve injury. We describe an all-arthroscopic direct-repair technique using a suture hook with 2-0 polydioxanone that is relatively simple and safe and is thus a useful alternative for radial tears of the TFCC. PMID:23061960

  4. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

    PubMed Central

    Woodmass, Jarret M; Esposito, John G; Ono, Yohei; Nelson, Atiba A; Boorman, Richard S; Thornton, Gail M; Lo, Ian KY

    2015-01-01

    Purpose Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. Methods Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH)” OR “acromioclavicular* (text)” OR “coracoclavicular* (text)” AND “Arthroscopy (MeSH)” OR “Arthroscop* (text)” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic. Level of evidence IV Results A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients. Conclusion Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels. PMID:25914562

  5. Arthroscopic repair of the subscapularis tendon: indications, limits and technical features.

    PubMed

    Osti, Leonardo; Soldati, Francesco; Buono, Angelo Del; Buda, Matteo

    2013-01-01

    The rationale to anatomically repair this tendon is to restore the functional biomechanics of the shoulder. Clinical and imaging assessment are required before undertaking arthroscopy. In this way, associated pathologies of the biceps and labrum may be successfully addressed. The arthroscopic repair of the tendon implies to use suture anchors and reinsert the tendon itself over the footprint. Results after arthroscopy are comparable to those observed after open procedures. PMID:24367783

  6. Arthroscopic repair of the subscapularis tendon: indications, limits and technical features

    PubMed Central

    Osti, Leonardo; Soldati, Francesco; Del Buono, Angelo; Buda, Matteo

    2013-01-01

    Summary The rationale to anatomically repair this tendon is to restore the functional biomechanics of the shoulder. Clinical and imaging assessment are required before undertaking arthroscopy. In this way, associated pathologies of the biceps and labrum may be successfully addressed. The arthroscopic repair of the tendon implies to use suture anchors and reinsert the tendon itself over the footprint. Results after arthroscopy are comparable to those observed after open procedures. PMID:24367783

  7. Arthroscopic Technique for the Treatment of Pigmented Villonodular Synovitis of the Hip

    PubMed Central

    Lee, Simon; Haro, Marc S.; Riff, Andrew; Bush-Joseph, Charles A.; Nho, Shane J.

    2015-01-01

    Open synovectomy remains the treatment of choice for pigmented villonodular synovitis (PVNS) of the hip but has shown modest results compared with the treatment of other joints. Recent advances in hip arthroscopy permit a thorough evaluation of the joint surfaces, improved access, and decreased postoperative morbidity. We describe an arthroscopic synovectomy technique for PVNS of the hip. The use of additional arthroscopic portals and creation of a large capsulotomy enable successful visualization and extensive synovectomy of the entire synovial lining of the hip. The T-capsulotomy enables extensive soft-tissue retraction for complete exposure. The midanterior portal enables use of an arthroscopic grasper and shaver to directly access and excise the synovial lining of the peripheral compartment while avoiding damage to the medial and lateral retinacular vessels. Technical innovations in hip arthroscopy have enhanced visualization in the central and peripheral compartments, as well as instrument management and diagnostic evaluation of the capsule, therefore allowing enhanced management of PVNS of the hip. PMID:25973372

  8. Arthroscopic management of proximal tibial fractures: technical note and case series presentation

    PubMed Central

    BENEA, HOREA; TOMOAIA, GHEORGHE; MARTIN, ARTUR; BARDAS, CIPRIAN

    2015-01-01

    Background and aims The purpose of this article is to describe a new surgical method of arthroscopy assisted treatment of intraarticular proximal tibial fractures (ARIF – arthroscopic reduction and internal fixation), analyzing its efficiency and safety on a series of patients. Tibial plateau fractures affect the proximal tibial metaphyseal and articular surface, representing 1.2% of all fractures and up to 8% of all fractures in elderly. Patients and method Our case series consists of 6 patients with Schatzker types I-III tibial plateau fractures, treated in the Orthopedic and Traumatology Clinic of Cluj-Napoca from July 2012 to August 2014. Patients included in the study presented Schatzker type I-III tibial plateau fracture. Results The results obtained with the arthroscopic method were excellent in 5 cases (mean Rasmussen score 27.60 points) and good in 1 case (mean score 23.75). The radiological consolidation appeared after a mean of 12 weeks. No major complication was noted. Conclusions Diagnosis and treatment of associated lesions, shortening of hospitalization length and postoperative rehabilitation, but also the lower rate of complications, can make arthroscopic reduction and internal fixation the method of choice for the operative treatment of selected Schatzker I-III types of proximal tibial fractures. PMID:26528076

  9. Arthroscopic stabilization of the shoulder for acute primary dislocations using a transglenoid suture technique.

    PubMed

    Salmon, J M; Bell, S N

    1998-03-01

    Many studies report the results of arthroscopic stabilization for recurrent shoulder instability, with widely variable recurrence rates; however, there are very few reports of the use of these techniques in acute first-time dislocations. We report the clinical outcomes of 17 patients who had arthroscopic stabilization using a transglenoid suture technique for acute primary dislocation. The surgery took place between March 1992 and March 1994 and, to date, there has been one recurrent dislocation (6%) and no recurrent subluxation. There were no major complications, although a number of patients found the knot tied over the infraspinatus fascia to be uncomfortable until it resorbed. All patients examined had normal power and range of motion, and a clinically stable shoulder. All 16 patients without recurrence were satisfied with their result. Nine patients returned to sports at the same or higher level, including such vigorous contact sports as Australian Rules football and rugby. Three patients did not return to the same level of sporting activity because of lack of confidence in the shoulder or a fear of dislocation despite no clinical evidence of instability. Five patients reported a lack of confidence in the shoulder without clinical evidence of instability. We suggest that arthroscopic stabilization with transglenoid sutures or a suture anchor technique is a reasonable option for the athlete with an acute primary shoulder dislocation who wishes to return to sports. PMID:9531124

  10. Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study

    PubMed Central

    Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo

    2009-01-01

    We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P?>?0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P? 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

  11. Variations in cell morphology in the canine cruciate ligament complex.

    PubMed

    Smith, K D; Vaughan-Thomas, A; Spiller, D G; Clegg, P D; Innes, J F; Comerford, E J

    2012-08-01

    Cell morphology may reflect the mechanical environment of tissues and influence tissue physiology and response to injury. Normal cruciate ligaments (CLs) from disease-free stifle joints were harvested from dog breeds with a high (Labrador retriever) and low (Greyhound) risk of cranial cruciate ligament (CCL) rupture. Antibodies against the cytoskeletal components vimentin and alpha tubulin were used to analyse cell morphology; nuclei were stained with 4',6-diamidino-2-phenylindole, and images were collected using conventional and confocal microscopy. Both cranial and caudal CLs contained cells of heterogenous morphologies. Cells were arranged between collagen bundles and frequently had cytoplasmic processes. Some of these processes were long (type A cells), others were shorter, thicker and more branched (type B cells), and some had no processes (type C cells). Processes were frequently shown to contact other cells, extending longitudinally and transversely through the CLs. Cells with longer processes had fusiform nuclei, and those with no processes had rounded nuclei and were more frequent in the mid-substance of both CLs. Cells with long processes were more commonly noted in the CLs of the Greyhound. As contact between cells may facilitate direct communication, variances in cell morphology between breeds at a differing risk of CCL rupture may reflect differences in CL physiology. PMID:22465617

  12. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

    PubMed Central

    Thorlund, J B; Juhl, C B; Roos, E M; Lohmander, LS

    2015-01-01

    Objective To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease. Design Systematic review and meta-analysis. Main outcome measures Pain and physical function. Data sources Systematic searches for benefits and harms were carried out in Medline, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2014. Only studies published in 2000 or later were included for harms. Eligibility criteria for selecting studies Randomised controlled trials assessing benefit of arthroscopic surgery involving partial meniscectomy, debridement, or both for patients with or without radiographic signs of osteoarthritis were included. For harms, cohort studies, register based studies, and case series were also allowed. Results The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small difference in favour of interventions including arthroscopic surgery compared with control treatments for pain (effect size 0.14, 95% confidence interval 0.03 to 0.26). This difference corresponds to a benefit of 2.4 (95% confidence interval 0.4 to 4.3) mm on a 0–100?mm visual analogue scale. When analysed over time of follow-up, interventions including arthroscopy showed a small benefit of 3–5?mm for pain at three and six months but not later up to 24 months. No significant benefit on physical function was found (effect size 0.09, ?0.05 to 0.24). Nine studies reporting on harms were identified. Harms included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. Conclusions The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time and absent at one to two years after surgery. Knee arthroscopy is associated with harms. Taken together, these findings do not support the practise of arthroscopic surgery for middle aged or older patients with knee pain with or without signs of osteoarthritis. Systematic review registration PROSPERO CRD42014009145. PMID:26383759

  13. The association of genes involved in the angiogenesis-associated signaling pathway with risk of anterior cruciate ligament rupture.

    PubMed

    Rahim, Masouda; Gibbon, Andrea; Hobbs, Hayden; van der Merwe, Willem; Posthumus, Michael; Collins, Malcolm; September, Alison V

    2014-12-01

    Angiogenesis-associated signaling is a fundamental component in the remodeling of the extracellular matrix in response to loading. Genes encoding protein components within this signaling cascade are therefore suitable candidates for investigation into ACL injury susceptibility: namely, vascular endothelial growth factor A isoform (VEGFA), kinase insert-domain receptor (KDR), nerve growth factor (NGF), and hypoxia inducible factor-1? (HIF1A). A case-control genetic association study was conducted on 227 asymptomatic control participants and 227 participants with surgically diagnosed ACL ruptures of which 126 participants reported a non-contact mechanism of rupture. All participants were genotyped for seven polymorphisms within the four genes. The VEGFA rs699947 CC genotype (p=0.010, OR: 1.92, 95% CI: 1.17-3.17) was significantly over-represented within participants with non-contact ACL ruptures. The VEGFA rs1570360 GA genotype was significantly over-represented in the CON group (p=0.007, OR: 1.70, 95% CI: 1.16-2.50). Furthermore, the KDR rs2071559 GA genotype was significantly over-represented in the female controls (p=0.023, OR: 2.16, 95% CI: 1.11-4.22). Inferred haplotype analyses also implicated genomic regions spanning the VEGFA and KDR genes. These novel findings suggest that regions within VEGFA and KDR may be implicated in the pathophysiology of ACL ruptures; highlighting the potential biological significance of angiogenesis-associated signaling in the aetiology of ACL ruptures. PMID:25111568

  14. Relationship Between Functional Knee Joint Position Sense and Functional Performance Scores Following Anterior Cruciate Ligament Reconstruction (Pilot Study)

    PubMed Central

    Kafa, Nihan; Ataoglu, Muhammed Baybars; Hazar, Zeynep; Citaker, Seyit; Ozer, Mustafa

    2014-01-01

    Objectives: The aim of this study was to assess the relationship between functional knee joint position sense (JPS) and functional performance following ACL reconstruction Methods: Seven male patients (mean age=32,66 ±6,47) who had undergone ACL reconstruction and 10 male healthy control subjects participated in the study. Knee joint position sense was evaluated by reproduction of 20° knee flexion angle in weight-bearing position with single and bilateral limb movement into flexion and extension. The deviations in the angle were recorded and compared to both noninjured side and healthy controls’. Functional performance was evaluated with Single Leg Hop Test in both injured and non-injured sides. The scores were also compared with healthy controls and non-injured sides. Relationship between measured values was tested with Spearman Correlation Analysis. Results: There was no significant difference in knee joint position sense in functional position between the operated and uninjured knees of patients or between patients and healthy controls (p>0,05). However, there is significant difference in Single Leg Hop test scores between operated and non-operated or between patients and healthy controls (p=0,037; p<0,05). There was no significant correlation between Single Leg Hop test scores and knee joint position sense (p>0,05). Conclusion: There was no evidence of impaired joint position sense in weight-bearing positions in subjects with ACL reconstruction but there was a decrease in functional performance. This decrease in functional performance may depend on the other parameters except proprioceptive deficits.

  15. Changes in Circulating Biomarkers of Muscle Atrophy, Inflammation and Cartilage Turnover in Patients Undergoing Anterior Cruciate Ligament Reconstruction and Rehabilitation

    PubMed Central

    Mendias, Christopher L; Lynch, Evan B; Davis, Max E; Enselman, Elizabeth R Sibilsky; Harning, Julie A; DeWolf, Paul D; Makki, Tarek A; Bedi, Asheesh

    2014-01-01

    Background Following ACL reconstruction, there is significant atrophy of quadriceps muscles which can limit full recovery and place athletes at risk for recurrent injury with return to play. The etiology of this muscle atrophy is not fully understood. Hypothesis We hypothesized that circulating levels of pro-atrophy, pro-inflammatory and cartilage turnover cytokines and biomarkers would increase following ACL reconstruction. Study Design Descriptive laboratory study. Methods Subjects (N=18, mean age 28±2.4 years) underwent surgical reconstruction of the ACL following non-contact athletic injury. Circulating levels of biomarkers were measured along with SF-12, IKDC and objective knee strength measures preoperatively, and at 6 postoperative visits. Differences were tested using repeated measures one-way ANOVA tests. Results Myostatin, TGF-? and CRP levels were significantly increased in the early postoperative period, and returned to baseline. COMP levels decreased immediately after surgery and then returned to baseline. CCL2, CCL3, CCL4, CCL5, EGF, FGF-2, IGF-1, IL-10, IL-1?, IL-1?, IL-1ra, IL-6, myoglobin and TNF-? were not different over the course of the study. Conclusions An increase in potent atrophy-inducing cytokines and corresponding changes in knee strength and functional scores were observed following ACL reconstruction. Clinical Relevance Although further studies are necessary, the therapeutic inhibition of myostatin may help prevent the muscle atrophy that occurs following ACL reconstruction and provide an accelerated return of patients to sport. PMID:23739685

  16. The Characterization of Mechanical Properties of a Rabbit Femur-Anterior Cruciate Ligament-Tibia Complex During Cyclic Loading

    NASA Astrophysics Data System (ADS)

    Sekiguchi, Hidetaka; Han, Jungsoo; Ryu, Jaiyoung; Han, Changsoo

    The purpose of this study was to investigate the effect of cyclic loading, which produced the condition of ACLs during sports activities, on tensile properties of femur-ACL-tibia complexes (FATCs). Paired FATCs of 40 New Zealand white rabbits were tested on a materials testing machine. One specimen of each pair was designated as a control and loaded until failure. The contralateral specimen was loaded cyclically (1.4 Hz, 1 hr.) with 20%, 30%, 40%, or 50% of ultimate tensile strength (UTS) of the control and then loaded until failure. The UTS and mode of failure were recorded after each test. Five specimens ruptured during cyclic loading in the 50% group. In the 40% group, the mean value of UTS of cycled specimens was significantly lower than that of controls. There was no statistically significant difference in UTS values between control and cycled specimens in the 20% and 30% groups. Cycled specimens had a significantly higher incidence of substance failure than controls. Our results demonstrated that FATCs have the strength to withstand cyclic loading within normal sports activity levels. However, FACTs can be damaged by cyclic loading under strenuous sports activity levels. We speculate that cyclic loading makes the ACL substance weaker than the insertion site.

  17. Abstract--The anterior cruciate ligament (ACL) functions as a mechanical stabilizer in the tibiofemoral joint. Over

    E-print Network

    Konofagou, Elisa E.

    experiment, bovine joints were excised, cast in an agar gel matrix and externally compressed. In a second ultrasound or MRI images acquired before and after a Manuscript received May 2, 2005. This work was supported

  18. Anterior femoroacetabular impingement: an update.

    PubMed

    Lequesne, Michel; Bellaïche, Laurence

    2012-05-01

    Anterior femoroacetabular impingement can cause early hip osteoarthritis. The typical patient is an adult younger than 50 years of age, often with a history of sporting activities. The main symptom is intermittent pain triggered by static flexion (low seats) or dynamic flexion (during sporting or occupational activities that require repeated hip flexion). The characteristic physical finding is pain triggered by placing the hip in internal rotation and 70 to 110° of flexion. In additional to anteroposterior and false-profile radiographs, lateral Dunn or Ducroquet views should be obtained on both sides to visualize the anterior part of the head-neck junction. Instead of being concave, the head-neck junction is either flat or convex, causing a cam effect that damages the labrum and anterosuperior cartilage. Non-sphericity of the femoral head with an anterior ovoid bulge induces a similar cam effect. In pincer impingement, which is less common, over-coverage by the anterosuperior acetabular rim pinches the labrum between the rim and the femoral head-neck junction when the hip is flexed. Pincer impingement is related to acetabular retroversion or protrusion. Arthrography coupled with computed tomography or magnetic resonance imaging visualizes the morphological abnormalities (e.g., ovoid shape of the femoral head or retroversion of the acetabulum) and detects secondary lesions such as labral tears or separation or damage to the anterosuperior cartilage. Arthroscopy allows removal of the damaged labrum and correction of the morphological abnormalities via femoroplasty to restore the normal concave shape of the neck and/or acetabuloplasty to eliminate over-coverage. Short- or mid-term results are satisfactory in 75 to 80% of patients. However, the presence of degenerative lesions in about two-thirds of patients at the time of arthroplastic surgery limits the probability of achieving good long-term results. PMID:22281229

  19. Intra-articular injection of hyaluronic acid following arthroscopic partial meniscectomy of the knee.

    PubMed